Feeding the injured brain: nutrients, dose, timing, and monitoring - PubMed

3 days ago

Nutrition is crucial for managing neurocritically ill patients, with the brain accounting for up to 25% of total resting energy expenditure (REE).
After brain injury, patients face inflammation, altered glucose metabolism, and catabolic stress.
Enteral nutrition is the preferred method, with early, low-dose initiation recommended within 24-48 hours.
Common challenges include feeding intolerance, aspiration risk, and altered gastrointestinal motility.
Parenteral nutrition may be used if enteral nutrition is insufficient or contraindicated, though early target feeding has shown harm in general ICU populations.
Key considerations include timing, energy and protein dosing, micronutrient supplementation, and metabolic monitoring via indirect calorimetry.
Emerging concepts like the ketogenic diet, exogenous lactate, and immunonutrition aim to optimize recovery and reduce secondary brain injury.
Personalized nutrition based on metabolic phenotyping and real-time monitoring requires further validation.
A multidisciplinary approach is recommended, viewing nutrition as a therapeutic intervention to influence neurological recovery and long-term outcomes.

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