[Metabolic disorders of chronically critically ill patients caused by consequences of traumatic brain injury].

The problem of chronic critical illness therapy is relevant all over the world. Revealing the metabolic function in patients in chronic critical condition is an important link in the development of adequate treatment and rehabilitation tactics. The aim - identification of metabolic features in chronic critical patients after brain injury in the first 3 days from the moment of admission to the rehabilitation center. Material and methods. Single-center observational study included a group of 25 patients with chronic critical illness, aged 38.7±14.0 years with body mass index 20.8± 4.3 kg/m2 (min 14.5; max 29.7), who were on independent breathing through a tracheostomy tube, and who have pronounced neurological disorders in the form of depression of minimally conscious state, FOUR scale from 12 to 16 points, as well as bedsores 1-2 stage and polysegmental pneumonia. The patients underwent indirect calorimetry and analysis of biochemical parameters of protein, carbohydrate, fat and mineral metabolism, as well as the level of nitrogen excretion with urine. Results and discussion. The data obtained indicate that chronic critical ill patients with the consequences of traumatic brain injury had pronounced metabolic disorders, mainly of a protein component. Total protein level decreased up to 61.0±9.4 g/l (min 39.1; max 83.1), albumin up to 30.2±6.0 g/l (min 17.4; max 37.8), prealbumin up to 0.13± 0.06 g/l (min 0.04; max 0.23) and transferrin up to 147.7±37.7 mg/dl (min 84.0; max 209.0). The patients' requirement in protein was 106.4±38.5 g/day (min 57.1; max 160.5) or 1.55±0.46 g/kg/day (min 0.75; max 2.22). The level of resting energy expenditure measured by indirect calorimetry was 1549.1±421.8 kcal/day (min 673.0; max 2430.0) or in terms of body weight 24.8±7.6 kcal/kg/day (min 12.4; max 45.8). Conclusion. The data obtained indicate a continuing catabolic phase in patients more than 30 days after the primary injury, which led to their chronic critical condition.

[Glutamine as a component of nutritional and metabolic therapy for surgical patients in ICU]. / Glutamin kak komponent nutritivno-metabolicheskoi terapii patsientov khirurgicheskogo profilya v usloviyakh ORIT.

Glutamine is the most abundant amino acid in the human body that is involved in various metabolic processes. The development of hypermetabolic and hypercatabolic syndrome that accompanies critical conditions of ICU patients is associated with a decrease in the concentration of glutamine, especially in the blood plasma and muscles. This process may last for quite a long time and lead to a number of complications up to a fatal outcome. This review was aimed to analyze clinical studies conducted over the past 20 years that demonstrate the effect of intravenous infusion of glutamine dipeptide as part of balanced parenteral nutrition on the perioperative period: the severity of inflammatory response; the state of the intestinal mucosa; the incidence and severity of complications; mortality; the duration of stay in the ICU and hospital in general, etc. The analysis was performed using systematic reviews and meta-analyses based on randomized double-blind, placebo-controlled trials in different countries selected in the main databases (PubMed, EMBASE, Web of Science, The Cochrane Library, etc.). Most of the reports state that the inclusion of glutamine dipeptide in nutritional and metabolic therapy (NMT) in surgical patients reduces the frequency and severity of infectious complications and mortality, reduces the length of stay in ICU and in hospital in general, improves the biochemical parameters that reflect the condition of patients, and reduces the treatment costs. Thus, the conducted systematic reviews and meta-analyses confirm that the use of the parenteral form of glutamine dipeptide (Dipeptiven 20%) as part of balanced standard parenteral nutrition (PN) is a clinically and pharmacoeconomically justified strategy of NMT in surgical ICU patients.

[Intestine morphology and microbiocenosis changes in critically ill patients in neurosurgery]. / Izmenenie morfologii i mikrobiotsenoza kishechnika u neirokhirurgicheskikh patsientov v kriticheskom sostoyanii.

In recent years, the effect of critical conditions on intestine and the role of such changes in maintenance and progression of systemic disorders are of particular attention. This issue is relevant in critically ill neurosurgical patients too. Intestine morphology and microbiome changes in these patients represent a wide field for researches in intensive care and prevention of secondary damage to other organs and systems. This review ensures a current approach to the problem of intestine morphology and microbiome changes in critically ill neurosurgical patients. We reviewed the data from clinical studies and experiments reproducing a critical condition in animals. Most publications are indexed in the PubMed, e-library, Google Scholar databases. We also analyzed the data from NEJM, JAMA, Lancet, Critical Care and other issues. The manuscript contains an overview of 44 foreign and 13 domestic references; over 50% of researches were published within the past 5 years. Searching depth was over 50 years.

[Factors limiting nutritional support for patients in chronic critical illness].

Patients in chronic critical illness after brain injury may experience various conditions that limit nutritional support. The aim of this work is to analyze the factors limiting or hindering the provision of nutritional support (in particular, enteral clinical nutrition) in patients in chronic critical illness after brain damage. Material and methods. This study is a prospective observational cohort study. In the course of the study, 47 patients (27 men and 20 women, mean age 52±18.4 years) in a chronic critical illness who were undergoing rehabilitation after brain damage and who had certain limitations in the provision of nutritional support were evaluated. The duration of the patients' stay in the intensive care unit was from 21 to 30 days. During hospitalization, adverse events and conditions were recorded in these patients, limiting the conduct of enteral clinical nutrition. Results. Among the undesirable phenomena and conditions limiting enteral nutrition, diarrheal syndrome most often developed - in 41.7% of patients (associated with the use of antibiotics in 25.0% of the examined). The second group in terms of frequency - the development of surgical pathology (of various etiology) - in 31.7% of patients, which attracted special attention, taking into account the neurological and/or neurosurgical nature of the underlying disease. At the same time, the appearance of a high residual volume of the stomach against the background of an increase in hydrocephalus developed only in 5.0% of cases. More attention should be paid to patients who are in the most severe physical condition, since they have a high probability of the occurrence of several factors at once that limit the use of clinical nutrition - this category of the studied sample included 19.1% of patients. Conclusion. Strict adherence to the technology of enteral nutrition can increase the efficiency of enteral nutrition in patients in chronic critical condition.

[Nutrition support for patients-servicemen in military-medical organizations of the Ministry of Defence].

Analysis of the state of nutritional support in military medical institutions of the Ministry of Defence of the Russian Federation. In order to study the state of nutritional support chiefs (heads) of anaesthesiology and resuscitation military medical organizations of the Ministry of Defense of the Russian Federation on the practice of Clinical Nutrition were interviewed. These amounts reflect the organization, strategy, equipment and the need for means and methods of nutritional support, depending on the level of the organization, as well as provide a basis for improving the practice of nutritionally metabolic support in critically ill patients.

[Enteral therapeutic nutrition in the complex therapy and prevention of diseases]. / Enteral'noe pitanie v kompleksnoi terapii i profilaktike zabolevanii.

Baseline nutritional impairments, patient's malnutrition, and inadequate correction of metabolic disorders considerably reduce the effects of therapeutic measures, increase the risk of septic and infectious complications, negatively influence the hospital length of stay, increase mortality rates. Concomitant and profound disorders of metabolic homeostasis system in various diseases and critical conditions dictate a multi-component approach to the correction of metabolic disorders requiring specially chosen nutrient compositions and the routes of their administration. The development of currently available nutritional formulae was based on the theory of balanced nutrition reflecting the physiological requirements in nutrients and calories of a healthy person, and also taking into account specific features of pathogenesis, clinical course, disease stage, the nature and extent of metabolic disorders, functional condition of the gastrointestinal tract, the effects of specific nutrients on the intensity of metabolic processes. Nutrition adapted to the patient's disease and the digestive tract functional condition provided by diets containing specific nutrients (arginine, glutamine, omega-3 fatty acids) has a number of advantages over standard nutritional formulae, and poses a directed therapeutic effect. The nutritional formulae "Nutrien" are represented by the standard ("Nutrien Standard"), and semi-elemental ("Nutrien Elemental") formulae, as well as by the formulae of directed effect ("Nutrien Hepa", "Nutrien Nephro", "Nutrien Pulmo", "Nutrien Diabet", "Nutrien Immun").

[Enteral therapy of the syndrome of intestinal insufficiency in patients with peritonitis]. / Enteral'naia terapiia sindroma kishechnoi nedostatochnosti u bol'nykh s peritonitom.

Sixty five patients with peritonitis were examined and divided into two groups. The operative intervention in all the patients included transnasal intubation of the small intestine. The basic enteral therapy used in the first group of patients was made with the glucose-saline solution and transition to a balanced polysubstrate mixture "nutrient standard" with the increasing concentration. For the patients of the second group a special program was developed for enteral therapy in which glutamine and pectine were included in the glucose-saline solution as well as nutrient mixtures containing middle chain triglycerides. Active decompression of the small intestine followed by the enteral administration of the nutrient mixtures facilitated quicker correction of the intestinal insufficiency in patients with severe forms of peritonitis.

[Some aspects of intensive care for severe forms of anaerobic non-sporeforming infections of soft tissues]. / Intensivnaia terapiia tiazhelykh form anaérobnoi neklostridial'noi infektsii miagkikh tkanei.

The results of treatment (in Hospital N.N. Burdenko) of 167 patients with anaerobic nonsporeforming ("nonclostridial") infection of soft tissues (ANIST) of various location are presented. Principal errors of intensive care in this category of patients, substantial difference in the course of infectious process in patients with ANIST depending the diseased area are shown. Programs of treatment for the patients with limited (up to 1600 cm2) and extended (over 1600 cm2) forms of ANIST are proposed. The effectiveness of such components of intensive care as ozonotherapy, correction of metabolic disturbances, HBO has been studied. Practical application of these programs allowed active influence on intoxication syndrome in ANIST which resulted in a decrease of lethality up to 10.2%.

[Artificial therapeutic nutrition using special food mixtures in complex treatment of patients]. / Iskusstvennoe lechebnoe pitanie s ispol'zovaniem spetsializirovannykh pishchevykh smesei v kompleksnoi terapii bol'nykh.

The experience of using special food mixtures for enteral nutrition in treatment of 5518 of the wounded and inpatients allows propose practical conception of using these artificial food mixtures at different pathological situations. The whole characteristics, nutritional and biological values of these mixtures and methodology of their applications are summarized.

[Colloid-oncotic pressure in patients with diffuse suppurative peritonitis]. / Sostoianie kolloidno-onkoticheskogo davleniia u bol'nykh s razlitym gnoinym peritonitom.

35 patients with various phases of generalized purulent peritonitis were tested. The goals of this study were to define the colloid-oncotic pressure (COP) and the contents of its main ingredient--albumin, determine the significance of the COP studies for the diagnosis of edema of lungs in cases of purulent peritonitis, and the influence of fluid management and parenteral nutrition upon the COP index. The studies have shown a clear dependency of COP and albumin ratio upon the phase of peritonitis. The authors come to a conclusion that the definition of COP dynamics is one of the most reliable criteria that makes it possible to chart a correct program of fluid management and reduce the number of postinfusional complications.

[Early diagnosis of acute renal insufficiency in patients with peritonitis]. / Ranniaia diagnostika ostroi pochechnoi nedostatochnosti u bol'nykh peritonitom.

Changes in osmolarity, blood and urine levels of medium-size molecules (MSM), osmolarity and MSM index, free water clearance (FWC) and alterations in traditional clinical and biochemical parameters typical of acute renal failure (creatinine, urea nitrogen, K+, Na+, diuresis) have been compared in 27 patients with peritonitis complicated in 17 cases by acute renal failure (ARF). In patients with developing ARF disturbances in osmotic condition, osmotic clearance, FWC, MSM level precede an increase in creatinine and urea nitrogen level and diuresis decrease. Dynamic studies of FWC and MSM blood and urine levels allow of early ARF diagnosis in patients with peritonitis. Progressive growth of plasma osmolarity and FWC with a parallel decrease in MSM index below 1 is a criterion indicative of functional renal failure turning into organic one.