Impact of early post-pyloric feeding during therapeutic hypothermia on outcomes in patients with traumatic brain injury: a retrospective cohort study

Abstract

Background Although therapeutic hypothermia (TH) is a standard critical care intervention for traumatic brain injury (TBI), it can significantly suppress gastrointestinal motility, leading to feeding intolerance (FI) rates as high as 40%–70%. Post-pyloric feeding (PPF), which bypasses the stomach, offers a potential solution. Nevertheless, the efficacy of PPF in improving outcomes for TBI patients receiving TH has not been established. Objective This study aimed to compare the effects of early post-pyloric feeding versus conventional nasogastric tube feeding on neurological outcomes and clinical endpoints in TBI patients undergoing therapeutic hypothermia. Methods In this single-center, retrospective cohort study conducted between January 2024 and June 2025, 122 eligible TBI patients were enrolled. Based on the enteral nutrition route established within 48 h of intensive care unit (ICU) admission, patients were divided into a PPF group (n = 67) and a nasogastric tube feeding (NGT) group (n = 55). All patients received standardized therapeutic hypothermia and nutritional support. The primary outcomes were 30-day neurological outcome and 30-day mortality. Secondary outcomes included the incidence of feeding intolerance, duration of mechanical ventilation, length of ICU stay, and nutritional laboratory indicators. Results No statistically significant differences were observed between the PPF and NGT groups in the 30-day favorable neurological outcome rate (29.85% vs. 30.91%, P = 0.900) or the 30-day mortality rate (10.44% vs. 7.27%, P = 0.582). The incidence of FI was significantly lower in the PPF group (13.43% vs. 30.91%, P = 0.019). Additionally, the PPF group had significantly shorter median durations of mechanical ventilation (11 [9–16] days vs. 15 [10–21] days, P = 0.012) and ICU stay (13 [11–20] days vs. 20 [13–29] days, P = 0.004). No significant differences were identified in nutritional laboratory indicators at the end of TH. Conclusion Although early PPF did not significantly improve short-term mortality or neurological outcomes in TBI patients undergoing TH, it effectively reduced the incidence of FI and shortened the duration of mechanical ventilation and ICU stay.