engleski

Appropriate management of patients with traumatic brain injury and dysphagia in our hospitals or not?

OBJECTVES: Traumatic brain injury (TBI) is the cause of various neurological deficits including swallowing disorders. Until now, the studies in patients with TBI show the incidence of dysphagia from 17.2 % to 61%. Enteral nutrition is preferential route of nutrition, fluid and drug administration vs parenteral nutrition. Percutaneous endoscopic gastrostom (PEG) feeding should be considered if the patient cannot have an adequate intake of nutriens (qualitatively or quantitatively) orally for a period 2-3 weeks. The aim of this study was to establish if the patients with TBI have proper treatment when having dysphagia before arrival on rehabilitation. METHODS: This retrospective study included 114 patients with TBI and disphagia (96 men and 18 women) that needed feeding tube and were on craniocerebral rehabilitation. Inclusion criteria were: age over 18 years, traumatic brain injury and first rehabilitation after injury. Exclusion criteria were: other etiology of disphagia and second time on rehabilitation or death during rehabilitation. We have analyzed patients date from 1.1.2012. to 1.9.2015. RESULTS: 26% patients with TBI needed feeding tube becouse of disphagia on their first rehabilitation after trauma. 24% had NG tube and 2% had PEG when they arrived on craniocerebral rehabilitation. Time from injury to arrival at rehabilitation was from 4 weeks to 20 weeks. At discharge from rehabilitation 15% of patients needed feeding tube. CONCLUSIONS: All 24% patients with TBI and NG tube needed to be referred with PEG on rehabilitation. Appropriate managment of this patients can reduce complications that manifest during medical rehabilitation (eg. the risk of malnutrition, risk of aspiration, risk of pneumonia, affect the length of the stationary type of medical rehabilitaton). In addition, there is evidence of intermediate level that postpyloric feeding associated with lower risk for pneumonia (30% compared to gastric feeding). According to literature, placement of a percutaneous endoscopic gastrostomy or percutaneous endoscopic jejunostomy tube is simple, safe and well-tolerated by patients. Doctors who managment patients with traumatic brain injury and disphagia shoud be inform about aforementioned.

traumatic brain injury, dysphagia, percutaneous endoscopic gastrostomy

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