Effect of Semi-elemental Enteral Nutrition on Gastrointestinal Tolerance in Patients With Traumatic Brain Injury.

Exclusion Criteria14

• GCS=3 with bilateral fixed and dilated pupils;
• Hemodynamic instability or respiratory failure: mean arterial pressure <70mmHg, PaO2/FiO2<150, PaCO2<30 mmHg or >45 mmHg, or lactate >5 mmol/l;
• Contraindications to both nasogastric and nasojejunal tube placement, or inability to complete tube placement within 48 hours of onset;
• Contraindications to enteral nutrition therapy or semi-recumbent positioning;
• Pre-existing intellectual disability or physical disability affecting outcome assessment;
• Gastrointestinal abnormalities likely to affect gastrointestinal function, such as short bowel syndrome (defined as total small bowel length ≤122 cm), ulcerative colitis, Crohn's disease, or any form of ostomy;
• Body mass index (BMI) <18kg/m2;
• Concomitant abdominal injury or extracranial injury with AIS score >3 in any region;
• Presence of malignancy, severe cardiac insufficiency (ejection fraction <50%), severe hepatic failure (Child-Pugh score ≥7), or severe renal failure (glomerular filtration rate ≤30 mL/min or serum creatinine ≥4mg/dL) at NICU admission;
• Concurrent severe disease with expected survival ≤14 days;
• Pregnancy, within 30 days postpartum, or breastfeeding;
• Refusal of treatment or receipt of palliative care;
• Patient or family declines informed consent;
• Current participation in another interventional clinical trial.