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Nutritional and metabolic supplementation for the injured brain

an update

Quintard, Hervéa; Ichai, Caroleb

Current Opinion in Critical Care: April 2019 - Volume 25 - Issue 2 - p 126–131
doi: 10.1097/MCC.0000000000000588
NEUROSCIENCE: Edited by Mauro Oddo

Purpose of review Energy dysfunction is increasingly recognized as a key factor in the pathogenesis of acute brain injury (ABI). This one characterized by a high metabolic rate and nitrogen loss is often associated with an undernutrition support. We review the metabolism evolution and nutritional status in brain injured patient and summarize evidence on nutritional support in this condition.

Recent findings The role of nutrition support for improving prognosis in brain injured patient has been underlined recently. A fast nutrition institution whatever the route is essential to prevent an imbalance in caloric support. Moreover, hypermetabolic state must be prevented with a sufficient nitrogen support. Glycemic control is particularly relevant in this group of patient, with the discovery of new fuel that could potentially improve cerebral metabolism and replace glucose. Few data support also the use of immunonutrition input in this group of patients.

Summary Nutritional support is a key parameter in brain injured patient and must be initiated quickly to counteract hypermetabolic state by caring to improve caloric and nitrogen input. Recent clinical data support the use of immunonutrition, glutamine and zinc in this particular setting.

aIntensive Care Unit, Pasteur 2 Hospital, CNRS UMR 7275

bIntensive Care Unit, Pasteur 2 Hospital, IRCAN (INSERM U1081, CNRS UMR 7284), NICE Cédex, University hospital of Nice, Nice, France

Correspondence to Professor Carole Ichai, Intensive Care Unit, Pasteur 2 hospital, CHU Nice, 30 voie Romaine, 06000 Nice, France. Tel: +33 492033300; e-mail:

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