Tolerance and efficacy of enteral nutrition for neurosurgical patients in pentobarbital coma

This retrospective study examined the tolerance of enteral nutrition in 32 of 67 consecutive, neurosurgical patients placed into pentobarbital-induced coma for intractable intracranial hypertension. Patients who had received at least 4 days of enteral nutrition were included. Patients with <4 days of enteral nutrition were excluded for reasons unrelated to feeding tolerance. All patients were fed by a 10-French, small-bore feeding tube placed blindly or endoscopically. Feeding-tube location was in the small bowel in 26 of 32 patients, intragastric in 4 patients, and not documented in 2 patients. Intolerance (>500 ml watery stool for 2 days, abdominal distention, or duodenal-gastric reflux) was observed in 3 of 32 patients. The patients received daily, on average, 92% ± 24% calories of their measured energy expenditure. This study demonstrates that patients placed into barbiturate coma can be successfully fed by the enteral route.