In patients requiring neurocritical care, stimulation of metabolism/catabolism by excessive stress can aggravate malnutrition, infections, and neurological prognosis. For this reason, it is necessary to assess the nutritional risk in these patients through nutritional evaluation and to begin early enteral nutrition if the digestive tract is functioning. The target energy dose is calculated with a predictive equation or a rule of thumb (25–30 kcal/kg/day) or an indirect calorimetry, with the protein dose target level set at 1.2 g/kg/day or higher. However, underfeeding should be undertaken in the first week if the nutritional risk is low. In cases with a high nutritional risk, feeding at the level of at least 80% of the target goal should be attempted during the first 72 h while paying close attention to the refeeding syndrome. Because acute hyperglycemia can worsen the neurological prognosis and increase the risk of complications, insulin administration should be started if the blood glucose level rises to ≧180 mg/dL. Appropriate nutritional therapy contributes to a better prognosis.
KeywordsNutritional assessment Nutritional risk Early enteral nutrition Underfeeding Glycemic control
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