Early Enteral Permissive Underfeeding in Critically Ill Young Adults with Traumatic Brain Injury: A Single-Blind Randomized Controlled Pilot Trial

Background and Objectives: There is no consensus on optimal initial energy requirements for critically ill patients. The present study aimed to compare the clinical outcomes of early enteral permissive underfeeding (EEPU) with those of early enteral standard feeding (EESF) in critically ill patients with traumatic brain injury (TBI). Materials and Methods: In this single-blind, randomized, controlled pilot trial, 60 young adults with TBI were randomly assigned to either EESF or EEPU groups (initiation energy goal: 100% vs. 30% of estimated energy requirements, respectively). Enteral feeding was administered during 24-48 hours of intensive care unit admission. Patients receiving EEPU were prescribed to achieve full energy requirements by day seven of the intervention. Results: The EEPU group demonstrated improved glycemic control (205.6±68 vs. 137.4±59 mg/dL, P=0.02), reduced duration of hospital stay (57.5±29 vs. 70.9±24 days, P=0.08) and shorter duration of mechanical ventilation (20.2±11 vs. 26.4±9 days, P=0.04). Gastrointestinal complications were more frequent in the EESF group (3.5±2 vs. 1.4±3 days, P=0.001). There were no differences between the EESF and EEPU groups in terms of 28-day mortality rate (3.8% vs. 10.7%, RR: 0.33; 95% CI: 0.03, 3.42; P=0.61).Conclusion: EEPU may be associated with beneficial effects on gastrointestinal toleration and glycemic control in young TBI patients, which might contribute to improved clinical outcomes in this population; however, further investigations are required on this issue. Trial registration: This trial was registered at Iranian Registry of Clinical Trials (www.irct.ir) as IRCT201201128709N1.