ABSTRACT
The brain is the primary gatekeeper of the metabolic activity of the entire body. Severe traumatic brain injury (TBI), therefore, predictably creates havoc in the metabolic milieu of the entire physiology.
It has been shown that in patients with severe TBI, elevated extracellular lactate is common, leading to the suggestion that lactate may be an effective energy substrate for the brain in these situations. Neither adequate resuscitation after trauma nor complete enteral diets have shown a reversal in the metabolic derangements specific to Neurotrauma. TBI and spinal cord injury (SCI) both result in severe hypercatabolism, although the estimation of basal energy requirements may be less than that predicted in patients with SCI because of muscle denervation. Indirect calorimetry to ascertain nutrition goals and early institution of nutrition supplements are desirable. The enteral path is preferred with full caloric goal attainment by 7 days. A multidisciplinary approach to nutrition in these patients will prevent dysimmunity and improve outcomes.
