Acute gastrointestinal injury develops in more than half of all patients in the intensive care unit, regardless of the underlying pathology. Determining the stage of acute gastrointestinal injury is necessary to choose the appropriate strategy of intensive therapy, leading to the fast gastrointestinal function recovery. The described strategy of intensive therapy, certain approaches to enteral therapy allow to improve prognosis and to reduce the duration of the disease among patients with severe gastrointestinal injury.
Prophylaxis, diagnostics and correction of nutritional status disturbances is considered as one of the main treatment methods of patients with COVID-19 infection-directed to resolve systemic inflammatory response and correction of metabolic response to a viral infection. Systemic Inflammatory Reaction (SIR) manisfestation as a result of viral infection leads to pronounced metabolic processes disturbances. The main metabolic manifestations of SIR is reflected as hypermetabolic-hypercatabolic syndrome with complex disturbances of protein, lipids and carbohydrates metabolism, increased consumption of carbohydrate-lipid reserves and breakdown of tissue proteins. Thus, adequate correction of metabolic disorders and a wholesome nutritional support, taking into account the clinical picture, severity of the disease, ongoing respiratory and intensive care therapy is an integral component in treating patients with COVID-19 infection which determines the efficiency of its treatment and reduction in mortality. Given the relevance of the problem, the authors decided that it was important to increase the COVID-19 treatment efficacy by producing guidelines based on the most fundamental provisions of the modern approach to nutritional support in critical patients with community acquired pneumonia, acute respiratory failure, ARDS, sepsis, multiple organ failure.
The paper summarizes data on modern approaches to the diagnosis, prevention and treatment of severe acute parenchymal respiratory failure of various origins, including ARDS due to bacterial viral pneumonia. The work is based on the data of modern well-organized studies, analysis of international clinical guidelines with a high degree of evidence, as well as the results of our own long-term experimental studies and clinical observations of the treatment of patients with ARDS of various origins, including viral pneumonia of 2009, 2016, 2020. Scientifically grounded algorithms for prevention, differential diagnosis and personalized therapy of severe acute respiratory failure using innovative medical technologies and a wide range of respiratory and adjuvant treatment methods have been formulated. The authors tried to adapt as much as possible the existing current recommendations for the daily clinical practice of anesthesiologists and resuscitators.
Acute respiratory failure has been and remains one of the main problems of modern medicine. Among the large number of high-tech methods of treating acute respiratory failure, adequate moisture and warming of the upper respiratory tract of the patient at all stages of the respiratory therapy are important. It should be noted that ensuring optimal moistening and warming of the inhaled gas mixture allows to avoid the development of many pulmonary complications. On the other hand, even with the use of the most modern treatment methods, inadequate microclimate in the upper respiratory tract can significantly reduce the effectiveness of their use. Thus, maintaining an adequate microclimate in the upper airways is normal, with various bronchopulmonary diseases and in conditions of respiratory support will improve the functional state of the lungs, prevent the development of many complications, reduce material costs and duration of treatment, reduce the mortality of this patient population. Despite the existence of the large database, the question of choosing the most effective technology to ensure homeostasis and protection of the upper respiratory tract in different clinical situations with different methods of respiratory support is still relevant. This dictates the necessity of continuing the research in this direction. This review is devoted to the current state of the problem of moistening, warming and filtering the breathing mix under conditions of prosthetic respiratory function.
Aim: to evaluate the efficacy of metabolic disorders perioperative correction and the completeness of providing macronutrients in cancer patients when standard and specialized sterilized mixtures for enteral nutrition are included in the nutritional support program. Patients and Methods: the analysis of the enteral nutrition clinical efficacy during the perioperative period in cancer patients using Nutrien line liquid sterilized mixtures was carried out. The treatment results of 89 patients with GIT neoplasms who were treated in the surgical department and ICU of the Main Military Clinical Hospital named after N.N. Burdenko and the F.I. Inozemtsev City Clinical Hospital were analyzed. Personalized metabolic and nutritional support was provided before and after surgery. The effectiveness of metabolic disorders correction after surgery was evaluated on the basis of specialized examination methods. Results: after preoperative nutritional support, there was a significant increase (average group values) in total protein — 67.3±1.2 g/L, albumin — 33.5±2.3 g/L, transferrin — 1.5±0.11 g/L (p<0.05), and the absolute WBC count — 969±39 109/L (p≤0.05). Group 2 showed a decrease in the number of patients with grade 2 nutritional deficiency (by 8.3±1.71%, p<0.05); group 3 — the number of patients with positive dynamics of nutritional deficiency resolution was less (by 4.5±1.1%, p<0.05). In the postoperative period, in patients with diabetes mellitus, respiratory insufficiency, purulent-septic complications, who required personalized nutritional therapy with specialized mixtures, normalization of metabolic parameters was achieved by the 7–10 days of the postoperative period, which was confirmed by normalization of biochemical parameters and a decrease in nutritive demand. Conclusion: the study results on the use of enteral nutrition mixtures in the complex of perioperative nutritional support in cancer patients showed high clinical efficacy and provided the possibility of choosing a mixture based on a specific clinical situation, taking into account a personalized nutritional support program. KEYWORDS: nutritional support, pharmaconutrients, enteral nutrition, liquid mixtures. FOR CITATION: Arykan N.G., Evdokimov E.A., Stets V.V. et al. Enteral nutrition in perioperative nutritional support and rehabilitation during surgical treatment of oncological diseases. Russian Medical Inquiry. 2021;5(3):138–144. DOI: 10.32364/2587-6821-2021-5-3-138-144.
Introduction. Glucocorticoids are used worldwide to control hyperinflammation in hospitalized COVID‑19 patients. Nevertheless, the debate on the appropriate initiation time, effective treatment duration and modes of administration is still ongoing.The aim of this retrospective group analysis was to evaluate the influence of early methylprednisolone (MP) administration mode on acute respiratory distress syndrome (ARDS) dynamics in patients with COVID‑19.Materials and methods. We performed a retrospective analysis of 61 patients, who received MP treatment in the infection unit of our institution. The patients were retrospectively grouped by the MP administration method: either pulse boluses (group 1), or initial loading bolus followed by continuous infusion (group 2). MP administration was initiated on day 3–4 after hospital admission, i. e., within the first 10 days of the manifestation of symptoms. This is an earlier corticoid administration start, than is being described in most publications.Results. The positive dynamics in the setting of MP therapy was more pronounced in the continuous infusion group. Intensive care unit (ICU) transfer was necessary for 10 patients (33.3 %) of group 2 and for almost twice as many (19 patients, 61.2 %) of group 1. Patients of group 1 required respiratory support escalation (to mechanical lung ventilation) more often. Overall survival at hospital discharge was 77.5 % in the bolus group (group 1) and 90.0 % in the continuous infusion group (group 2).Conclusion. Based on our experience and the results of statistical analysis, the early use of MP (within 10 days of the first symptoms manifestation) in the ‘bolus followed by continuous infusion’ mode in the setting of the infection unit may reduce disease severity, decrease the need for respiratory support escalation, lower the number of cases of non-invasive and invasive lung ventilation and increase survival of COVID‑19 patients. These results must be further studied in randomized controlled studies.
Asynchronies (desynchronies, dyssynchrony) is a disturbance of the harmonious interaction between the patient’s respiratory system and а ventilator. Asynchronies occur as a result of various reasons and with any form of respiratory support (non-invasive, assisted or fully controlled mechanical ventilation). Asynchrony is a significant cause of biomechanics and gas exchange disorders in the development of both self-injury and ventilator-induced lung injury, an increase of the respiratory support duration and mortality in patients with respiratory failure. Understanding the mechanisms of the asynchrony pathogenesis and assessment of the patient’s respiratory system condition make it possible to timely identify and resolve disturbance of the patient-ventilator interactions. The article presents a classification, the main causes of development, diagnostic and correction methods of different variants of desynchronies in patients with respiratory disorders during of respiratory support.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.