Editorial: Critically ill head injury patients and nutritional issues; need for rural guidelines

Underfeeding in critically ill patients has been associated with adverse outcomes, increased incidence of infection and may result in longer hospitalization. In these critically ill patients, early and adequate nutritional support can promote healing, decrease physiological stress, and enhance immunocompetence. Most patients with severe traumatic brain injury regain their nutritional independence within the first 6 months after injury, however many may develop signs of malnutrition. Malnutrition leads to impaired respiratory muscle function, reduction in vital capacity, reduced cardiac contractility, increased thrombogenicity, and impaired renal function. The manifestations of these include hypoventilation, renal failure, non-healing of wounds, emotional and behavioral functional impairment. Gastrointestinal dysfunction occurs frequently in patients with traumatic brain injury.