Effect of parenteral-enteral versus enteral nutritional therapy on serum total protein, albumin, bilirubin, triglyceride and glucose in head-injured patients

ABSTRACT

Head-injured patients demonstrate an increased metabolic and catabolic rate, hyperglycemia, negative nitrogen balance, weight loss, muscle atrophy and multiple organ failure, including gastrointestinal and respiratory failure. These events may be due to hormonal changes and secretion of acute phase reactants. Therefore, this study was undertaken to assess the effect of parenteral-enteral versus enteral nutritional therapy on several serum parameters in head-injured patients in order to determine the preferred method of controlling these parameters. This prospective, quasi-experimental randomized study was performed in a 36 months period on 66 head-injured patients. Fifty-five males and 11 females with an age range of 18 to 72 years, who were admitted within 24 hours of their injury and who had a Glasgow Coma Scale [GCS] score of 4 to 10, were enrolled in this study. The patients were randomly allocated into two groups in order to receive either parenteral-enteral nutrition [Group 1] or enternal nutrition alone [Group 2]. They were followed for 14 days during their admission in the hospital. Group 1 received a statistically significant higher caloric intake [p<0.001]. This group had a higher mean total serum protein [p=0.037], total bilirubin and triglyceride [p<0.001], while serum albumin in both groups showed no statistically significant difference. Mean total bilirubin and triglyceride were higher in Group 1 [p<0.001 and p<0.001, respectively]. However, these findings were not found at the end of the second week. Although mean serum glucose was higher in Group 1 during the first week [p<0.001], no significant difference was noted during the second week. The parenteral-enteral method can provide more calorie and protein to head-injured patients in the early post-traumatic critical days. This method is more successful in maintaining serum protein within normal limits. However, increase in serum levels of triglyceride, bilirubin and blood sugar are more common while using this route and hyperglycemia must be controlled carefully