How should nutrition be delivered when a patient cannot swallow after TBI, and what considerations apply?

• A. Total parenteral nutrition via intravenous route only.
• B. Enteral feeding via nasogastric/orogastric tube, with post-pyloric access if aspiration risk; monitor tolerance and caloric goals.
• C. Wait for swallow reflex before feeding.
• D. Rely on oral supplements only.

Answer: (B)

When swallowing is not possible after a TBI, the goal is to keep the gut fed through enteral nutrition whenever the GI tract is usable, because it preserves gut integrity and lowers infection risk compared with intravenous feeding.

Start with enteral feeding using a tube placed through the nose or mouth into the stomach (nasogastric or orogastric). If there is a high risk of aspiration or problems with gastric emptying, use a post-pyloric route (nasojejunal or nasoduodenal tube) so nutrients are delivered beyond the stomach. This approach helps reduce the chance of food entering the lungs while still providing calories and nutrients.

Carefully monitor how well the feeds are tolerated—watch for signs like nausea, vomiting, abdominal distension, diarrhea, or other intolerance—and ensure that caloric and protein goals are met, adjusting the rate and formulation as needed to meet the increased metabolic demands often seen after TBI. Total parenteral nutrition via IV should be reserved for when the gut cannot be used or cannot meet needs. Relying on oral supplements alone is not appropriate when the patient cannot swallow safely. If swallowing ability improves, transition toward oral intake while continuing to monitor for safety and tolerance.