Table 5.12 Timing of Enteral Feeding for Nutritional Management Post ABI
|
Author Year Country Research Design PEDro Sample Size |
Methods |
Outcomes |
|
Chourdakis et al. (2012) Greece RCT PEDro=6 N=59 |
Population:TBI; Delayed Enteral Feeding (DEF) Group (n=25): Mean Age=33.3yr; Gender: Male=21, Female=4; Mean GCS Score=5.22. Early Enteral Feeding (EEF) Group (n=34): Mean Age=36.13yr; Gender: Male=26, Female=8; Mean GCS Score=5.81. Intervention: Patients admitted to the ICU were randomly allocated to receive either DEF (2-5 days post admission) or EEF (initiated within the first 24-48 hr of admission). Measurements were taken on day 1, 6 and 12. Outcome Measure: Hormone levels, dietary information. |
1. The EEF group began enteral feeding approximately 31 hr post admission and the DEF group began approximately 77 hr post admission. 2. Kilocalories administration was lower in the DEF group compared to the EEF group (p<0.01). 3. Several endocrine changes were noted for the groups, with the EEF group showing significant improvements compared to the DEF group (p<0.05). 4. No differences were noted in mortality and morbidity in either group despite enteral feeding. |
|
Minard et al. (2000) USA RCT PEDro=5 N=27 |
Population: TBI; Time Post-Injury=≤6 hr; Early Group (n=12): Mean Age=30yr; Gender: Male=9, Female=3; Mean GCS Score=7. Late Group (n=15): Mean Age=36yr; Gender: Male=10, Female=5; Mean GCS=7. Intervention: Patients were randomly assigned to either early (within 60 hr of injury) or late enteral feeding. The late group received feeding when tolerated by the patient (i.e., gastroparesis was resolved). Outcome Measure: Infection rates, Length of stay, ventilator days, instances of pneumonia, mortality. |
1. No significant differences between groups with regard to mortality, length of stay, ventilator days, number of infections per patient or patients with pneumonia. 2. Admission GCS score was a good predictor of infection (p<0.003), Length of stay in the ICU (p<0.02), and ventilator days (p<0.007). |
|
Taylor and Fettes (1998) UK RCT PEDro=4 N=82 |
Population: Head Injury. Intervention Group (n=41): Median Age=34yr. Control Group (n=41): Median Age=28yr. Intervention: Patients were randomly assigned to receive either the standard Enteral Nutrition (EN) or the early EN. EN was initiated from day 1; however, in the control group, EN was gradually increased from 15 mL/hr up to estimated energy and nitrogen requirements. In the intervention group, feeding was administered at a rate that met estimated energy and nitrogen requirements. Outcome Measures: Nutritional intake, nitrogen balance, volume of gastric residuals, incidence of pneumonia. |
1. Overall, patients received EN during 57% of the potential feeding time, with the longest interruption to feeding time coming from the rest period (13%). 2. Patients receiving early EN had a greater energy and nitrogen intake compared to standard EN patients over the initial week following brain injury (p<0.02). 3. Intervention patients received a higher volume of enteral fluid (p<0.02) but did not have a higher incidence of pneumonia or aspiration. |
|
Chaudhry et al. (2017) USA Case Series N=3343 |
Population: TBI; Early (n=877): Age:(<18)=17, (18-49)=260, (50-64)=162, (>65)=438; Gender: Male=560, Female=317. Standard (n=1300): Age: (<18)=33, (18-49)=309, (50-64)=278, (>65)=679; Gender: Male=899, Female=401. Late (n=1166): Age(<18)=49, (18-49)=284, (50-64)=271, (>65)=562; Gender: Male=807, Female=359. Intervention: A national inpatient sample from 2011-2013 was analyzed. Outcomes of patients with TBI that received either early, standard (7-14days) or late percutaneous endoscopic gastronomy (PEG) placement for nutritional support were compared. Outcome Measures: Charleston Comorbidity Index (CCI), Length of Stay (LOS), complications, mortality. | 1. Early PEG placement times seemed to correlate with lower CCI scores, while late PEG placement times were correlated with higher CCI scores. 2. Patients in the late PEG group had the longest LOS. 3. Patients in the later PEG group seemed to have more complications. 4. Overall mortality during hospitalization was 6.39% for the early PEG group, 5.08% for the standard PEG group, and 5.67% for the late PEG group. |
|
Azim et al. (2016) United States Case Control N= 90 |
Population: Mean Age=41.6 yr; Gender: Male=66, Female=24; Mean GCS=3. Intervention: Patients who received early tube feeding (<24 hr) were compared to those who had late tube feeding (>24 hr). Outcome Measures: Mortality, pneumonia, aspiration, bacteremia, ICU-free days, ventilator-free days. |
1. There were no significant differences between groups in terms of mortality as a result of early versus late tube feeding. |
|
Dhandapani et al. (2012) India PCT N=67 |
Population: TBI; Time Post-Injury ≤24 hr; Total enteral feeding (≤3 days) Group: Mean Age=31.7 yr. Total enteral feeding (4-7 days) Group: Mean Age=34.4 yr. Total enteral feeding (>7 days) Group: Mean Age=37.2 yr. Intervention: Participants were administered enteral feeding as early as possible; before 3 days, at 4-7 days, and after 7 days. The volume of feed was increased gradually in keeping with an individual’s gastric tolerance. Outcome Measures: Glasgow Outcome Scale (GOS), Mid-Arm Circumference (MAC), Mid-Arm Muscle Circumference (MAMC), and serum total protein. |
1. Those receiving total enteral feeding >7 days post injury lost significantly more MAC and MAMC compared to those in the earlier fed groups (p≤0.001). 2. Analysis of total serum protein revealed that more malnutrition was seen in those who received total enteral feeding >7 days post-injury (p≤0.005). 3. At the 3 and 6 mo follow-up, those receiving total enteral feeding within the first 7 days were more likely to have favourable outcomes on the GOS. |