Enteral Feeding During Barbiturate Coma

Abstract

The extended use of pentobarbital coma in head-injured patients creates a feeding problem because of the drug-induced ileus. We evaluated the tolerance and safety of enteral feeding for head-injured patients in pentobarbital coma. Baseline nutritional assessments of the 22 patients revealed no severe nutritional deficits. Pentobarbital was initiated on admission at a rate of 128 ± 39 mg/hr for 9.9 ± 6.0 days. Enteral feedings were started at a rate of 25 ml/hr and were increased according to tolerance to a predetermined maximum rate which required 6.5 ± 4.5 days. Daily chest x-rays revealed no aspiration pneumonia. Whereas eight patients tolerated enteral feedings, seven had minor gastrointestinal complications, including diarrhea (n = 5) and constipation (n = 2). A total of 11 patients had residual volumes of 50 ml or more, but only four required alteration of the solution or route of administration. These data indicate that the majority of patients in pentobarbital coma can safely be fed enterally with only minor complications.

Get full access to this article

View all access options for this article.

References

Pappas TN , Mironovich RO Barbiturate-induced coma to protect against cerebral ischemia and increased intracranial pressure. Am J Hosp Pharm 1981 ;38:494-8.

Selman WR , Spetzler RF , Roski RA Barbiturate coma in focal cerebral ischemia. J Neurosurg 1982;56:685-90.

Rapp RP , Young B. , Twyman D. , et al. The favorable effect of early parenteral feeding on survival in head-injured patients. J Neurosurg 1983 ;58:906-11.

Clifton GL , Robertson CS , Contant CF Enteral hyperalimentation in head injury. J Neurosurg 1985;62:186-93.

Twyman D. , Young B. Positive nitrogen balance in head injured adults receiving a high nitrogen enteral formula, In: Traumacal. feeding the hypermetabolic patient: Clinical experience. Evansville, IN: Mead-Johnson, 1983:50-9.