Continuous Parenteral Nutrition to Reduce Pneumonia: Its Effects on Severe Head Injury Patients in Hasan Sadikin Hospital Bandung, Indonesia
Abstract: The aim
of this study
was to compare
the effects of
enteral-, standard- and
continous-parenteral
nutrition therapy to
reduce incidence of
pneumonia in severe
head injury (SHI) patients. We
used nutrition therapy
as one of the
treatments for reducing
pneumonia in SHI patients.
Twenty one brain-injured
patients with peak
24-hour admission Glasgow
Coma Scale (GCS) scores
of 4-8 were
prospectively and randomly
assigned to receive
continuous total parenteral nutrition
(TPNC) for 24
hours nonstop, total
parenteral nutrition standard
(TPNS) and enteral nutrition (EN) in March-May 2011. Patients were
observed up to 14 days post injury. Pneumonia
was assessed by using clinical, radiology and laboratory tests with the
incidence of pneumonia
significantly different among
groups (p<0.05). The
GCS changes over
time among groups were
significantly different; nutritional
assessment parameters such
as anthropometry were not
significantly different among
groups; total lymphocyte
count was significantly increased in TPNC group;
albumin was significantly increased in 7th and 14th day post injury in TPNC group
(p < 0.05).
Absolute lymphosit count
was significantly increased
on 7th day
and 14th day post
injury in TPNC
group (p <
0.05). Incidence of
pneumonia was significantly decreased in
TPNC group (p
< 0.05). Calories
and protein given
by TPNC within
24 hours nonstop can
be administered better
in acute SHI
patients than by
EN via nasogastric
routes. Neurological
recovery from SHI
occurs more rapidly
in patients with
better and earlier nutritional support, especially in
TPNC group.
Author: Farid Yudoyono,
Muhammad Z. Arifin
Journal Code: jpkedokterangg110219
