Valentina Colombo*, Pamela Salucci, Francesca Cesira Cava, Giuseppe Bonavina, Alice Rita Portillo, Elisa Maietti and Roberto Piperno
Background: Literature regarding enteral feeding modalities in patients with Disorder of Consciousness (DOC) secondary to Acquired Brain Injury (ABI) is scant. Gastro-esophageal reflux and aspiration pneumonia are common in this patient population. Intermittent bolus feeding via Percutaneous Endoscopic Gastrostomy (PEG) and adoption of a more physiological posture during feeding may reduce morbidity and mortality. The primary study aim was to evaluate the incidence of lung infections in DOC patients treated with high-speed intermittent enteral nutrition in a verticalized position. Secondary aims were to assess the impact of this management on patient care, nutritional status, sleep-wake rhythm, and functional status.
Methods: Eight patients were monitored over 12 weeks and followed up 12 months after ABI. Enteral nutrition was administered starting from a speed of 64 ml/h and increased by 50 ml/h every 3 days. Collected data included: signs of infection, gastrointestinal tolerance, time in/out of bed, nutritional parameters, polysomnography, disability and cognitive scales.
Results: There were no gastrointestinal side-effects and no lung infections occurred. Nutritional status and sleep patterns improved. Time out of bed increased. Cognitive scale scores indicate an improvement in cognitive and disability profile.
Conclusion: Intermittent high-speed enteral nutrition via PEG did not increase infection risk and did not interfere with rehabilitation goals. Larger studies are needed to draw conclusive evidence on the management of enteral feeding and posture reconditioning in DOC patients.
