What is the recommended approach to nutrition in the neurocritical care bundle for TBI?

• A. Early enteral nutrition is encouraged to support metabolic demands
• B. Delaying nutrition until day 7
• C. Nutrition is not critical in the early phase
• D. Only intravenous parenteral nutrition should be used

Answer: (A)

Initiating feeding early through the enteral route is recommended in neurocritical care after TBI because the brain and body enter a high, catabolic energy state. Early enteral nutrition helps meet the increased caloric and protein needs, preserves gut mucosal integrity, and lowers the risk of infections compared with delaying feeding or relying solely on parenteral nutrition. In practice, feeding is started within roughly the first 24 to 48 hours (as soon as the patient is hemodynamically stable and there are no contraindications) and advanced as tolerated. If enteral feeding isn’t feasible, parenteral nutrition can be considered as a supplement, but it’s not the preferred first approach. Delaying nutrition to day 7 misses a critical window for supporting recovery and is associated with worse outcomes. Nutrition plays a crucial role early on, and the enteral route is the favored method because of its benefits for metabolism, gut integrity, and infection risk.