Patients who suffer a moderate to severe TBI should have their nutritional needs met as soon as possible after the injury. New studies have indicated that the body heals better when proper nutrition is provided, above the minimum once thought to be adequate.

Patients are likely to receive fluids through an intravenous for a period of time after their injury, but should also receive oral or enteral nutrition as soon as possible. After injury, the brain requires heightened nutrition in order to begin healing. Patients should receive nutritional supplementation via a gastric feeding tube if they are unable to take in orally the extra calories they need to recover. This may improve the patient’s chances of survival in severe injuries.

Acute Phase

Because TBI often affects younger people, patients are usually well nourished before their injury; however, if proper attention is not given to their nutritional status, they may soon deplete their nutritional reserves. This is because the stress of a major injury, such as a TBI, causes a hypercatabolic state in which the body requires more calories to function. Without proper nutrition, muscle mass may be lost and the patient may suffer immune system dysfunction.

If a person with TBI is not able to swallow food, then nutritional support should be initiated via feeding tube. Liquid food is given to the patient through a tube which is inserted through the nose and into the stomach. Caloric needs for healing should be calculated by a dietitian or nutritionist.

If it is determined that supplemental feeding may be required for more than 4 to 6 weeks, a peg (percutaneous endoscopic gastronomy) tube may be inserted. This tube is inserted through the abdomen and into the stomach and allows for more comfort for the patient and also makes continuous feeding easier.

Liquid nutrition is complete and designed to meet a person’s total requirements for nutrition. A dietitian or nutritionist will calculate the patient’s nutritional requirements, whether the patient is fed orally or tube-fed, by considering the patient’s caloric, healing, weight, protein, and fluid requirements. Other factors the nutritionist or dietician may take into consideration are the presence of wounds, infections, concurrent injuries, and pre-existing medical problems.

Nutritional requirements will be reevaluated frequently during the acute phase following TBI. As the patient improves, the nutritionist will plan for the future with the patient or family and provide teaching towards the patient’s eventual discharge.

Rehabilitation Phase

Some patients with severe TBI may require tube feeding for a prolonged period of time. To assess readiness for oral feeding a speech therapist will assess the patient’s ability to manipulate food in the mouth and swallowing ability.

Patients with TBI should be provided a diet that is nutritionally optimized to assist healing of the brain. If the patient has suffered a loss of appetite or changes in ability to smell and taste, they may be served small, frequent meals and snacks, and foods that have a strong natural flavor. Supplementation with oral formulas may be necessary. A dietitian can help choose a suitable oral formula or supplement if needed.

Malnutrition is associated with longer hospital stays and an increase in complication rates; therefore, adequate nutrition is vital to improving patient outcomes.