Successful enteral nutritional support in the neurocritical care unit

Purpose: Adequate caloric intake is associated with improved outcome in neurocritical illness, but factors influencing the provision of enteral nutrition (EN) have not been systematically evaluated. The primary goal of the study was to determine the EN intake of neurosurgical intensive care unit (ICU) patients within the first week of illness and investigate the factors contributing to achieving caloric goals. Methods: A retrospective cohort of adult patients admitted to the neurosurgery service (NS) during August 2005-August 2006 were randomly selected and stratified into three groups based on their ICU-admission Glasgow Coma Scale Score (GCS) (GCS > 11, GCS 8-11, GCS 4-7). Daily EN intake, GCS, and other clinical data were collected. Results: A total of 71 patients were included (GCS > 11 = 23, GCS 8-11 = 23, GCS 4-7 = 25). Admitting diagnoses included traumatic brain injury (TBI) (32%), subarachnoid hemorrhage (SAH) (32%), and intracerebral hemorrhage (17%). The overall in-hospital mortality was 23.9%. Overall, the maximum daily mean calories provided was 1,100 kcal (mean of 55% of caloric goal on hospital day 6). The median time to feeding was approximately 3 days in each group. GCS did not appear to significantly affect the mean % of caloric goal administered in patients with a minimum daily GCS ≤ 11 (P = 0.053). Multivariate analysis revealed that clinical care factors, such as time to EN orders and enteral access confirmation, were significant impediments to EN provision (P = 0.001). Conclusion: System-based clinical care factors appear to have great impact on the successful provision of EN in the first week of neurocritical illness.