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

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.