Nutrition Management of Patients with Severe Brain Injury at The Ottawa Hospital: A 2-Year Cohort
CCCF ePoster library. Golka C. Nov 8, 2018; 233405
Colleen Golka
Colleen Golka
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Abstract
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Background:  Severe traumatic brain injury (sTBI) is associated with significant morbidity and mortality.  Early enteral nutrition is an important component of sTBI management.  Patients not fed within the first week of sustaining a TBI have increased likelihood of death.  The updated American Society of Parenteral and Enteral Nutrition guidelines (2016) and the Brain Trauma Foundation guidelines (4th Ed. - 2016) have provisions for early initiation and nutrition targets based on the best available evidence. We present the results of a sTBI management audit at The Ottawa Hospital (TOH) which has an ICU-specific enteral nutrition protocol and dedicated Registered Dietitians as members of our ICU multidisciplinary team.



Objective:  We aimed to examine the nutrition management of a 2-year cohort of patients with sTBI and identify potential targets for a quality improvement intervention.



Methods:  This is a single-centre retrospective cohort of consecutive patients with sTBI admitted to an Academic Level 1 Trauma Tertiary Care hospital between 01 January 2014 and 31 December 2015. From an existing prospective trauma registry and all hospital admission records, we included patients that: (a) were ≥16 years of age, (b) had sustained blunt (non-penetrating) head injury, and (c) had a post resuscitation Glasgow Coma Score (GCS) <9, or deteriorated to GCS <9 within 24h of presentation. We excluded all patients who had neurologic improvement within 48h. For all eligible patients, data was collected and merged from the existing databases and from primary chart review.  Nutrition data collected included time to nutrition initiation, time to target calories and protein determination, time to target calories and protein reached and feeding tube position.



Results:  Of the 795 patient records screened, 188 were classified as meeting the inclusion criteria, 62 were excluded leaving a final cohort of 126. From this cohort, 103 (82%) required ICU admission and nutrition intervention with 93% receiving some form of enteral nutrition. Early enteral nutrition, starting within 48 hours of ICU admission, was achieved in 98% of patients. Post-pyloric feeding tubes were documented in 11% of patients enterally fed. 35 patients died within 48h. Calorie and protein targets were assessed for 73 patients.  56 (80%) and 53 (83%) patients met their calorie and protein targets, respectively, by ICU day 5. By ICU day 7, 67 (96%) and 60 (94%) patients had met their respective calorie and protein requirements.



Conclusion: Our data presented demonstrates that we are meeting guidelines in providing early enteral nutrition and meeting energy and protein targets within the recommended time frames for most patients with sTBI in a unit with an ICU-specific enteral nutrition protocol and the support of dedicated Registered Dietitians.  A better understanding of factors that affect meeting these targets in all patients is needed to tailor specific interventions.

 


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