Which statement about monitoring nutrition during enteral feeding in TBI patients is true?

• A. Tolerance and caloric goals should be monitored during enteral feeding.
• B. Caloric goals can be ignored in critical illness.
• C. Post-pyloric access should be avoided at all costs.
• D. Nutrition should be delayed until the patient is fully awake.

Answer: (A)

Monitoring nutrition during enteral feeding in TBI patients focuses on delivering the right amount of calories while watching how well the gut tolerates the feed. In moderate to severe brain injury the body is in a stressed, hypermetabolic state, so energy needs are higher and change over time. Set a caloric target based on weight or more precise methods when available (like indirect calorimetry) and regularly compare the actual calories delivered to that goal. If intake is lagging, adjust the rate, the formula, or consider alternatives to improve delivery; if there are signs of overfeeding, adjust accordingly. Tracking tolerance is essential because feeding intolerance—such as vomiting, abdominal distension, high gastric residuals, or diarrhea—can prevent adequate nutrition and increase complication risk, and may prompt strategies like prokinetics or changing the access route.

Early enteral nutrition is generally favored to support healing and neuro recovery, with careful monitoring rather than delaying nutrition until the patient is fully awake. Post-pyloric access can be used when there is a high risk of aspiration or persistent gastric intolerance, but it’s not a universal requirement to avoid or pursue at all costs.