Changing requirements along the journey: The patient with a catastrophic head injury

摘要

Background: In Australia, around 1 in 45 Australians acquire a brain injury.(AIHW, 2007). Many of these patients are young and have the potential to live for many years. There is documented evidence for energy requirements for patients with an acquired brain injury (ABI) in the acute sector, but little evidence about their long term requirements. Aim: To provide evidence of weight change and energy requirements long term that will contribute to improved dietetic care, and optimized independence and decreased risk of lifestyle related diseases for the ABI patient. Methods: Two young adult male patients were selected, both were wheelchair bound. A third female patient was selected, who was discharged without a mobility aid. These patients no longer had a PEG tube in situ. The weights were recorded on a graph and the percent of weight gained above the weight goal was calculated. Two long term patients were selected, who remained nil by mouth, and whose weights were stable. The energy per kg was calculated for these 2 patients and compared to a standard energy equation. Results: All three patients on an oral diet gained excess weight over and above their goal weight ranges (7%, 16%, and 9%). The patients on PEG feeds had an estimated energy intake of 80-95 kJ/kg. Conclusions: Failure to address the change in energy requirements of patients with an ABI may result in significant unplanned weight gain in a patient group who already are likely to have significantly reduced mobility and independence. This study provides evidence towards the need for further research in this area.