Enteral Feeding During Barbiturate Coma

The extended use of pentobarbital coma in head-injured patients creates a feeding problem because of the drug-induced ileus. We evaluated the tolerance and safety of enteral feeding for head-injured patients in pentobarbital coma. Baseline nutritional assessments of the 22 patients revealed no severe nutritional deficits. Pentobarbital was initiated on admission at a rate of 128 ± 39 mg/hr for 9.9 ± 6.0 days. Enteral feedings were started at a rate of 25 ml/hr and were increased according to tolerance to a predetermined maximum rate which required 6.5 ± 4.5 days. Daily chest x-rays revealed no aspiration pneumonia. Whereas eight patients tolerated enteral feedings, seven had minor gastrointestinal complications, including diarrhea (n = 5) and constipation (n = 2). A total of 11 patients had residual volumes of 50 ml or more, but only four required alteration of the solution or route of administration. These data indicate that the majority of patients in pentobarbital coma can safely be fed enterally with ...