| Description |
Traumatic brain injury (TBI) produces severe derangements in metabolic and physiologic function with significant ramifications for determining nutritional therapy. The ability to understand the nature of current metabolic indicators is essential to improving the outcome from TBI. This study is a retrospective exploratory analysis of the predictive value and structural nature of current variables related to metabolic energy expenditure. The variables evaluated in this study address pertinent processes of nutritional metabolism including injury classification, indices of metabolic expenditure advocated in the literature, concurrent treatments in TBI, clinical vital signs, neurological responses, glucose synthesis, protein synthesis and nitrogen excretion, and immune responses. Analysis of the data included descriptive, correlational, predictive (regression), and factor modeling. Significant results include the lack of precision of current methods of restimating caloric expenditure in this population. Further, only 31% of this sample energy expenditure values as measured by indirect calorimetry were in the normal metabolic range as predicted by the Harris-Benedict Equation. Cost effectiveness of indirect calorimetry was further analyzed and found to be less expensive than alternative methods. Factor analysis of the metabolic variables provided a unique structure for conceptualizing the dimensions the metabolic variables represent. Patients with TBI display unique metabolic patterns with significant implications for monitoring and supplementation. An integrated management model for nutrition in TBI is proposed with recommendations for timing of initiation, caloric supplementation, and delivery methods. Research implications are discussed |
