Summary

  1. There is Level 4 evidence indicating that individuals with a low level of consciousness and those with tracheotomy tubes are at greater risk for pneumonia.
     
  2. There is Level 1b evidence that povidone-iodine is not beneficial in preventing ventilator-associated pneumonia.
     
  3. There is Level 2 evidence that providing oral hygiene education to patients post TBI results in a significant reduction of dental plaque, measured by the Plaque Index Score.
     
  4. There is Level 4 evidence of a hypermetabolic state in the acute period following ABI. The extent of the response can be moderated by barbiturates
     
  5. There is Level 2 evidence suggesting enteral nutrition and parenteral nutrition is effective in providing an increase in calories to patients with ABI.
     
  6. There is conflicting data when looking at the nitrogen balance of patients with ABI as to which method of feeding is most effective.
     
  7. Based on a single RCT, there is Level 2 evidence that TPN can safely be administered without causing serum hyperosmolality or influencing intracranial pressure levels in patients post ABI.
     
  8. There is Level 1b evidence, based on a single RCT, that enhanced enteral nutrition can reduce the incidence of infection, and reduce both the ventilator dependency period and length of stay.
     
  9. There is Level 1b evidence suggesting the early enteral nutrition results in a better hormonal profile of patients with TBI and may contribute to better clinical outcomes.
     
  10. There is Level 2 evidence suggesting that initiating enteral feeding at goal rate will increase the percentage of prescribed energy and protein actually received.
     
  11. There is Level 2 evidence that early parenteral nutrition support of closed head-injury patients appears to modify immunologic function by increasing CD4 cells, CD4-CD8 ratios, and T-lymphocyte responsiveness to Con A.
     
  12. There is Level 1b evidence that the risk of developing pneumonia is higher among ventilated patients (stroke and head injury) fed by a naso-gastric tube compared with a gastrostomy tube.
     
  13. There is Level 1b evidence indicating that metoclopramide is not effective as an aid to gastric emptying.
     
  14. Based on a single RCT there is Level 1b evidence that zinc supplementation in ABI patients has a positive effect on neurological recovery as measured by the Glasgow Coma Scale. However, no significant improvement in mortality rates could be attributed to zinc supplementation.
     
  15. Based on a single RCT, there is Level 2 evidence that high nitrogen feedings of approximately 2 g protein/kg are necessary to restore the substantial nitrogen loses that occur post ABI.
     
  16. There is Level 2 evidence that supplementation of BCAAs in patients with ABI enhances recovery of cognitive function, without negatively effecting tyrosine and tryptophan concentration.