A major goal of therapy after acute head injury is to prevent increased intracranial pressure. Treatments of intracranial pressure include measures such as hyperventilation, ventricular catheters, hypothermia, osmotic dehydration, sedatives, and in some cases, steroids. If these measures are not effective, barbiturate therapy is used to reduce brain metabolism, decrease cerebral blood flow, and suppress responses to stimulation. Barbiturates produce central nervous system effects that decrease gastrointestinal tone and motility. Clinicians must consider the specific effects of barbiturates and the unique nutritional needs of head-injured patients in order to select effective nutritional support regimens.
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References
1.
Rimel R.Head injury: a challenging future for neurosurgical nursing [Guest Editorial] . J Neurosurg Nurs1982;14:207-9.
2.
Pitts L., Martin N.Head injuries. Surg Clin North Am1982;62:47-60.
3.
Ammons AACerebral injuries and intracranial hemorrhages as a result of trauma . Nurs Clin North Am1990;25:23-33.
4.
Buhrley LE, Reed DJThe effect of furosemide on sodium-22 uptake into cerebrospinal fluid and brain. Exp Brain Res1972;14:503-10.
5.
Gionatta SL, Wiess MH, Puzzo LJ, et al. High dose glucocorticoids in the management of severe head injury . Neurosurgery1984;15:497-501.
6.
Woster PS, LeBlanc KLManagement of elevated intracranial pressure. Clin Pharm1990;9:762-72.
7.
Miller JD, Leech P.Effects of mannitol and steroid therapy on intracranial volume-pressure of intracranial volume pressure relationships in patients. J Neurosurg1975;42:274-81.
8.
Eisenberg HM , Barlow CF, Lorenzo AVEffect of dexamethasone on altered brain vascular permeability. Arch Neurol1970;23:18-22.
9.
Galicich JH, French LAUse of dexamethasone in the treatment of cerebral edema resulting from brain tumors and brain surgery. Am Pract Dig1961 ;12:169-174.
10.
Ward JD, Becker DP, Miller JD, et al. Failure of prophylactic barbiturate coma in the treatment of severe head injury. J Neurosurg1985;62:383-8.
11.
Marshall LF , Smith RW, Shapiro HMThe outcome with aggressive treatment in severe head injuries, Part 2; Acute and chronic barbiturate administration in the management of head injury. J Neurosurg1979 ;50:26-30.
12.
Smith A.Barbiturate protection in cerebral hypoxia. Anesthesiology1977;47:285-93.
13.
Quandt CW, de los Reyes RA, Diaz FGBarbiturate-induced coma for the treatment of cerebral ischemia: a review of outcome. Clin Pharm1982;1:549-51.
14.
Piatt JH, Schiff S.High dose barbiturate therapy in neurosurgery and intensive care. Neurosurgery1984;15:427-44.
15.
Bates J., McClain CJThe effect of severe zinc deficiency on serum levels of albumin, transferrin, and prealbumin in man. Am J Clin Nutr1981 ;34:1655-60.
16.
Heinemeyer G.Clinical pharmacokinetic considerations in the treatment of increased intracranial pressure. Clin Pharmacokinet1987;13:1-25.
17.
Bayliff CD, Schwartz ML, Hardy BGPharmacokinetics of high dose pentobarbital in severe head trauma . Clin Pharmacol Ther1985;38:457-61.
18.
Piatt J., Schiff S.High dose barbiturate therapy in neurosurgery and intensive care. Neurosurgery1984;15:427-41.
19.
Harvey SCHypnotics and sedatives. In: Goodman LS, Gilman A, eds. The pharmacological basis of therapeutics. 7th ed. New York : MacMillan Publishing Company , 1985:351-71.
20.
Carlon GC, Kahn RC, Goldiner PL, et al. Long term infusion of sodium thiopental. Crit Care Med1978;6:311-6.
21.
Bettice D.The cause of vomiting of tube feedings by neurosurgical patients. J Neurosurg Nurs1971;3:93-112.
22.
Miller JD, Becker DP, Ward JD, et al. Significance of intracranial hypertension in severe head injury . J Neurosurg1977;47:503-16.
23.
Hayder W., Lackner F., Schlick W.Metabolic changes in the course of severe acute brain damage. Eur J Intens Care Med1975;1:19-26.
24.
Clifton GL, Robertson CS, Contant CFEnteral hyperalimentation in head injury. J Neurosurg1985;62:186-93.
25.
Clifton GL, Robertson CS, Grossman RG, et al. The metabolic response to severe head injury. J Neurosurg1984;60:687-96.
26.
Rapp RP, Young B., Twyman D., et al. The favorable effect of early parenteral feeding on survival in head injured patients. J Neurosurg1981 ;58:906-11.
27.
Hadley MN, Grahm TW, Harrington T., et al. Nutritional support and neurotrauma. A critical review of early nutrition in 45 acute head injury patients. Neurosurgery1986;19:367-73.
28.
Blackburn GL , Bistrian BRNutritional care of the injured and/or septic patient. Surg Clin North Am1976;56:1192-224.
29.
Dempsey DT, Guenter P., Mullen J.Energy expenditure in acute trauma to head with and without barbiturate therapy . Surg Gynecol Obstet1985;160:126-34.
30.
Gadisseux P. , Ward J., Young H., et al. Nutrition and the neurosurgical patients . J Neurosurg1984;60:219-32.
31.
Ott L., Young B., Phillips R., et al. Brain injury and nutrition. NCP1990;5:68-73.
32.
Andrassy RJ , Durr EDAlbumin: use in nutrition and support. NCP1988;3:226-9.
33.
Olivares L. , Segovia A., Revuelta R.Tube feeding and lethal aspiration in neurological patients: a review of 720 autopsy cases. Stroke1974;5:654-7.
34.
Norton J., Ott L., McClain C.Intolerance to enteral feeding in the brain-injured patient. J Neurosurg1988;68:62-6.
35.
Vane D., Shiffler M., Grosfeld J., et al. Reduced lower esophageal sphincter (LES) pressure after acute and chronic brain injury. J Pediatr Surg1982 ;17:960-3.
36.
Burks TF, Galligan JJ, Porrea F., et al. Regulation of gastric emptying. Fed Proc1985;44:2897-901.
37.
Schwab WCNeedle catheter jejunostomy as a separate "mini-laparotomy" procedure using anesthesia. Contemp Surg1978;28:1-6.
38.
Drew JH, Koop CE, Grigger RPA nutritional study of neurosurgical patients with special reference to nitrogen balance and convalescence in the postoperative period. J Neurosurg1947;4:7-15.
39.
Young B., Ott L., Norton J., et al. Metabolic and nutritional sequelae in the non-steroid treated head injury patient. Neurosurgery1985;17:784-91.
40.
Young AB, Oh L., Beard D., et al. The acute phase response of the brain injured patient. J Neurosurg1988;69:375-80.
41.
Long CL, Schaffer N., Geiger JW, et al. Metabolic response to injury and illness: estimation of energy and protein needs from indirect calorimetry and nitrogen balance. JPEN1979;3:452-6.
42.
Degrote E.The CNS control of glucose metabolism. Acta Neurochir Supp1981;31:1-161.
43.
Burke JF, Wolfe RR, Mullany C.Glucose requirements following burn injury. Ann Surg1979;190:274-283.
44.
Wolfe RR, Allsop JR, Burke JFGlucose metabolism in man: responses to intravenous glucose infusion . Metabolism1979;28:210.
45.
Deutschman CS, Konstantinides FN, Raup S., et al. Physiological and metabolic response to isolated closed head injury. J Neurosurg1987;66:388-95.
46.
Middaugh PAEarly nutritional management post head injury . Trauma1989;4:17-23.
47.
Fruin AH, Taylor C., Pettis MSCaloric requirements in patients with severe head injuries. Surg Neurol1986;25:25-8.
48.
McClain CJ, Hennig B., Ott L., et al. Mechanisms and implications of hypoalbuminemia in head injured patients. J Neurosurg1988;69:386-92.
49.
Bradley JA, King RF, Schorah EJ, et al. Vitamins in intravenous feeding: a study of water soluble vitamins and folate in critically ill patients receiving intravenous nutrition. Br J Surg1978;65:492.
50.
Boosalis MG , Edlund D., Mondry B., et al. Circulating blood and twenty-four hour urinary levels of water soluble vitamins: are current intravenous multivitamin preparations adequate?Nutrition1988;4:431-8.
51.
McClain CJ, Twyman DL, Ott LG, et al. Serum and urine zinc response in head injured patients. J Neurosurg1986;64:244.
52.
Fried RC, Dickerson RN, Guenter P., et al. Barbiturate therapy reduces nitrogen excretion in acute head injury. J Trauma1989;29:1558-63.
53.
Miller JDBarbiturates and raised intracranial pressure. Ann Neurol1979;6:189-93.
54.
Yos HRHead injury and the treatment of increased intracranial pressure. In: Marshall SB, Marshall LF, Vos HR, Chestnut RM, eds. Neuroscience critical care . Philadelphia: WB Saunders, 1990:173-209.
55.
Ott L., McClain C., Young B.Nutrition and severe brain injury. Nutrition1989;5:75-9.
56.
Rall T.Barbiturate pharmacological properties. In: Goodman L, Gilman A, eds. Pharmacological basis of therapeutics. 8th ed. New York: MacMillan Publishing Company , 1990:360.
