EFFECTS OF PARENTERAL-ENTERAL VERSUSENTERAL NUTRITION ON NEUROLOGICAL STATUSANDOUTCOME OF HEAD-INJURED PATIENTS

Head injury is a major worldwide health problem and may cause metabolic disruption toward increased energy expenditure and protein catabolism. In head-injured patients, inadequate nutritional support can cause impaired healing, increased tendency to infections, multiple organ failure and poor recovery and outcome. Objective: To compare the effects of parenteral-enteral nutrition versus enteral support alone on complications, recovery and final outcome. Methods: A prospective quasi-experimental, randomized, non-blinded study was performed on 66 purely head-injured patients (55 males and 11 females, aged 18-72 years) with 24-hour-admission peak Glasgow Coma Scale (GCS) scores of 4 to 10. Patients were randomly divided into two groups; Group 1 received total parenteral nutrition, gradually changing to enteral nutrition, and Group 2, received enteral nutrition alone. They were studied for 14 days in hospital and followed after 3 and 6 months post-injury by Glasgow Outcome Score (GOS). Results: GCSs on the 14th day and GOSs three months post-injury were significantly higher in Group 1 than Group 2 (p=0.023, p=0.039, respectively), but GOSs after 6 months were not significantly different. Coma duration and mortality rate revealed no statistically significant difference between the two groups. While a statistically significant difference was found in complication rate and the total WBC counts between the two groups, the lymphocyte count was significantly higher in Group 1 (p < 0.001). Anthropometric indices were not statistically significantly different, except for the percentage of body weight loss and the difference between the weights of the 1st and the 14th days, which were significantly higher (P < 0.001). Group 1 received a higher calorie intake (36.07±3.55 cal/kg/day vs. 30.86±5.42 cal/kg/day in Group 2, p<0.001), and had a higher cumulative calorie balance (83.38±6.36% vs. 67.49± 9.54%, p<0.001). Mean protein intake in Group 1 was 1.35±0.15 gm/kg/day, as compared to 0.98±0.18 gm/kg/day in Group 2 (p < 0.001). Conclusion: Head-injured patients can receive more calories and proteins via the parenteral-enteral route. Recovery occurs more rapidly in these patients with better early nutritional support, but long-term follow-up reveals no statistically significant difference in the effectiveness of each nutritional regimen on the final outcome.