Resting energy expenditure in patients with isolated head injuries and spontaneous intracranial haemorrhages.

Indirect calorimetry was performed during the first seven days in 39 neurosurgical patients with isolated head injuries (N = 20) and with spontaneous intracranial haemorrhage (N = 19). All patients were artificially ventilated and received total parenteral nutrition during the whole study period. In the trauma group resting energy expenditure (REE) varied from 473-2172 kcal/m(2)/day and in patients with spontaneous haematomas from 552-1591 kcal/m/day. These were 56-265% (trauma) and 61-192% (spontaneous haemorrhages) of predicted basal metabolic rates (BMR). Patients with head injuries showed higher REE values than patients with spontaneous haemorrhage, which was significant (p < 0.001) for the differences between the two study groups and for coma grade II patients. Deeper coma resulted in lower energy expenditure in patients with head injuries but the decrease was significant only from coma grade I to II. The authors conclude that REE rarely exceeds 30% of predicted BMR in patients with spontaneous haemorrhage and 50% in trauma patients. However, the effect of coma on REE should be taken into account when devising nutritional support in this group of patients.