Full-text of the article is available for this locale: Русский.
Keywords
stroke
protein-energy malnutrition
hypoalbuminemia
body weight
protein-energy malnutrition
hypoalbuminemia
body weight
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Ershov V.I., Leyderman I.N., Belkin A.A., Gorbachev V.I., Gritsan A.I., Lebedinskii K.M., Petrikov S.S., Protsenko D.N., Solodov A.A., Shchegolev A.V., Borzdyko A.A., Dobrynin A.S., Silkin V.V., Zabolotskikh I.B. Protein-energy malnutrition prevalence and influence on complications and outcome of severe stroke, requiring mechanical ventilation: a multicenter prospective observational trial. Annals of Critical Care. 2024;(1):58–68. doi:10.21320/1818-474X-2024-1-58-68.
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Abstract
INTRODUCTION: Stroke is characterized by high prevalence and mortality. Protein-energy deficiency is a common syndrome in this category of patients, affecting the course and outcomes of cerebral stroke. OBJECTIVE: The purpose of the study was to analyze the prevalence and impact on the course and outcome of stroke of protein-energy deficiency in patients with mechanical ventilation. MATERIALS AND METHODS: A multicenter observational clinical study “Register of respiratory therapy in patients with stroke (RETAS)” was conducted under the auspices of the Russian Federation of Anesthesiologists and Reanimatologists. The study involved 14 centers, included 1289 acute stroke patients received respiratory support. RESULTS: Protein-energy deficiency in patients with stroke on mechanical ventilation was associated with a tendency to a greater risk of a lethal outcome (p = 0.0003). The absence of protein-energy malnutrition in patients with stroke severity less than 14 points during mechanical ventilation was associated with a greater likelihood of a positive outcome (Glasgow Outcome Scale, GOS 4 and 5) compared with patients with signs of malnutrition (p = 0.000002). Protein-energy malnutrition is associated with prolonged stay in ICU of patients with stroke on mechanical ventilation (p < 0.0001). At the same time, the group of patients with prolonged mechanical ventilation was characterized by a high prevalence of bedsores (p < 0.0001), hypoproteinemia, hypoalbuminemia (р = 0.0001), and decreased body weight 10 percent or more (p < 0.0001). The presence of protein-energy malnutrition was accompanied by an increased risk of ventilator-associated tracheobronchitis in patients with stroke (p < 0.0001). CONCLUSIONS: Protein-energy malnutrition significantly influences on the course and clinical outcome parameters of severe cerebral stroke patients on mechanical ventilation.
References
- Robertson S.T., Grimley R.S., Anstey C., et al. Acute stroke patients not meeting their nutrition requirements: investigating nutrition within the enriched environment. Clinical Nutrition. 2020; 39(5): 1470–7. DOI: 10.1016/j.clnu.2019.06.009
- Шестопалов А.Е., Попова Т.С., Лейдерман И.Н. и др. Нутритивная терапия при критических состояниях. В кн.: Интенсивная терапия: национальное руководство. Краткое издание: в 2 т. Под ред. И.Б. Заболотских, Д.Н. Проценко. 3-е изд., перераб. и доп. М.: ГЭОТАР-Медиа, 2023; 1: 97–109. ISBN 978-5-9704-7512-6. DOI: 10.33029/9704-6128-0-IT-2023-1-624 [Shestopalov A.E., Popova T.S., Leyderman I.N., et al. Nutritional therapy in critical conditions. In: Intensive care: national guidelines. Brief edition: in 2 volumes. Ed. I. B. Zabolotskikh, D. N. Protsenko. 3rd ed. Moscow: GEOTAR-Media, 2023; 1: 97–109. ISBN 978-5-9704-7512-6. DOI: 10.33029/9704-6128-0-IT-2023-1-624 (In Russ)]
- Поляков И.В., Лейдерман И.Н., Золотухин К.Н. Проблема белково-энергетической недостаточности в отделении реанимации и интенсивной терапии хирургического профиля. Вестник интенсивной терапии. 2017; 1: 57–67. DOI: 10.21320/1818-474X-2017-1-57-67. [Polyakov I.V., Leiderman I.N., Zolotukhin K.N. The Problem of Malnutrition in Surgical Intensive Care Unit. Intensive Care Herald. 2017; 1: 57–67. DOI: 10.21320/1818-474X-2017-1-57-67 (In Russ)]
- Dávalos A., Ricart W., Gonzalez-Huix F., et al. Effect of malnutrition after acute stroke on clinical outcome. Stroke. 1996; 27(6): 1028–32. DOI: 10.1161/01.str.27.6.1028
- Ершов В.И., Белкин А.А., Заболотских И.Б. и др. Российское многоцентровое обсервационное клиническое исследование "Регистр респираторной терапии у пациентов с ОНМК (RETAS)": сравнительный анализ исходов ОНМК при осуществлении ИВЛ. Вестник интенсивной терапии имени А.И. Салтанова. 2020; 4: 28–41. DOI: 10.21320/1818-474X-2020-4-28-41 [Ershov V.I., Belkin A.A., Zabolotskikh I.B., et al. Russian multicenter observational clinical study “Register of respiratory therapy for patients with stroke (RETAS)”: a comparative analysis of the outcomes of stroke during mechanical ventilation. Annals of Critical Care. 2020; 4: 28–41. DOI: 10.21320/1818-474X-2020-4-28-41 (In Russ)]
- José I.B., Leandro-Merhi V.A., Aquino J.L.B. Target, prescription and infusion of enteral nutritional therapy of critical patients in intensive care unit. Arq Gastroenterol. 2018; 55(3): 283–9. DOI: 10.1590/S0004-2803.201800000-72
- Mulherin D.W., Cogle S.V. Updates in Nutrition Support for Critically Ill Adult Patients. Hosp Pharm. 2017; 52(1): 17–26. DOI: 10.1310/hpj5201-17
- Aller M.A., Arias J.I., Alonso-Poza A., et al. A review of metabolic staging in severely injured patients. Scand J Trauma Resusc Emerg Med. 2010; 18: 27. DOI: 10.1186/1757-7241-18-27
- Wada A., Kawakami M., Otsuka T., et al. Nitrogen balance in patients with hemiparetic stroke during the subacute rehabilitation phase. J Hum Nutr Diet. 2017; 30(3): 302–8. DOI: 10.1111/jhn.12457
- Парфенов А.Л., Петрова М.В., Пичугина И.М. и др. Формирование коморбидности у пациентов с тяжелым повреждением мозга и исходом в хроническое критическое состояние (обзор). Общая реаниматология. 2020; 16 (4): 72–89. DOI: 10.15360/1813-9779-2020-4-72-89 [Parfenov A.L., Petrova M.V., Pichugina I.M., et al. Comorbidity Development in Patients with Severe Brain Injury Resulting in Chronic Critical Condition (Review). General Reanimatology. 2020; 16 (4): 72–89. DOI: 10.15360/1813-9779-2020-4-72-89 (In Russ and Engl)]
- Arsava E.M., Aydoğdu I., Güngör L., et al. Nutritional Approach and Treatment in Patients with Stroke, An Expert Opinion for Turkey. Turk J Neurol. 2018; 24(3): 226–42. DOI: 10.4274/tnd.92603
- Hoffer L.J., Bistrian B.R. Nutrition in critical illness: a current conundrum. F1000Res. 2016; 18(5): 2531. DOI: 10.12688/f1000research.9278.1
- Wirth R., Smoliner C., Jager M., et al. Guideline clinical nutrition in patients with stroke. Exp Transl Stroke Med. 2013; 5(1): 14. DOI: 10.1186/2040-7378-5-14.
- Грицан А.И., Горбачев В.И., Ершов В.И. и др. Программа регистра респираторной терапии больных с острым нарушением мозгового кровообращения. Свидетельство о государственной регистрации программы для ЭВМ № RU 2019619217. Российская Федерация. Номер заявки 2019615999. Дата регистрации 21.05.19. Дата публикации 15.07.19. [Gritsan A.I., Gorbachev V.I., Ershov V.I., et al. Programma registra respiratornoj terapii bol’nykh s ostrym narusheniem mozgovogo krovoobrashcheniya. Svidetel’stvo o gosudarstvennoj registratsii programmy dlya EVM № RU 2019619217. Rossijskaya Federatsiya. Nomer zayavki 2019615999. Data registratsii 21.05.19. Data publikatsii 15.07.19. (In Russ)]
- Лейдерман И.Н., Грицан А.И., Заболотских И.Б. и др. Периоперационная нутритивная поддержка. Методические рекомендации Федерации анестезиологов и реаниматологов. Вестник интенсивной терапии им. А.И. Салтанова. 2021; 4: 7–20. DOI: 10.21320/1818-474X-2021-4-7-20 [Leiderman I.N., Gritsan A.I., Zabolotskikh I.B., et al. Perioperative nutritional support. Clinical practice recommendations of the national “Federation of Anesthesiologists and Reanimatologists”. Annals of Critical Care. 2022; 4: 7–20. DOI: 10.21320/1818-474X-2021-4-7-20 (In Russ)]
- Петриков С.С., Попова Т.С., Хубутия М.Ш. Парентеральное и энтеральное питание. Национальное руководство. М.: ГЭОТАР-Медиа, 2023. ISBN: 978-5-9704-7277-4. [Petrikov S.S., Popova T.S., Khubutia M.Sh. Parenteral and enteral nutrition. National guidelines. Moscow: GEOTAR-Media, 2023. ISBN: 978-5-9704-7277-4. (In Russ)]
- Sabbouh T., Torbey M.T. Malnutrition in Stroke Patients: Risk Factors, Assessment, and Management. Neurocrit Care. 2018; 29(3): 374–84. DOI: 10.1007/s12028-017-0436-1
- Пасечник И.Н., Щучко А.А., Скобелев Е.И. Клинические риски в отделении реанимации и интенсивной терапии: как обстоят дела с энтеральным питанием? Анестезиология и реаниматология. 2022; 2: 80–6. DOI: 10.17116/anaesthesiology202202180 [Pasechnik I.N., Shchuchko A.A., Skobelev E.I. Clinical risks in intensive care unit: how are things with enteral nutrition? Russian Journal of Anaesthesiology and Reanimatology. 2022; 2: 80–6. DOI: 10.17116/anaesthesiology202202180 (In Russ)]
- Ершов В.И., Белкин А.А., Горбачев В.И. и др. Российское многоцентровое обсервационное клиническое исследование «Регистр респираторной терапии у пациентов с ОНМК (RETAS)»: инфекционные осложнения при искусственной вентиляции легких. Анестезиология и реаниматология. 2023; 1: 19–25. DOI: 10.17116/anaesthesiology202301119 [Ershov V.I., Belkin A.A., Gorbachev VI, et al. Russian multicenter observational clinical study “Register of respiratory therapy for patients with stroke (RETAS)”: infectious complications of mechanical ventilation. Russian Journal of Anaesthesiology and Reanimatology. 2023; 1: 19–25. DOI: 10.17116/anaesthesiology202301119 (In Russ)]
- Kim Y., Lee M., Mo H.J., et al. The association between malnutrition status and hemorrhagic transformation in patients with acute ischemic stroke receiving intravenous thrombolysis. BMC Neurol. 2023; 23(1): 106. DOI: 10.1186/s12883-023-03152-3
- Лейдерман И.Н., Грицан А.И., Заболотских И.Б. и др. Метаболический мониторинг и нутритивная поддержка при проведении длительной искусственной вентиляции легких. Методические рекомендации Общероссийской общественной организации «Федерация анестезиологов и реаниматологов». Анестезиология и реаниматология. 2022; 5: 6–17. DOI: 10.17116/anaesthesiology20220516 [Leyderman I.N., Gritsan A.I., Zabolotskih I.B., et al. Metabolic monitoring and nutritional support following long-term mechanical ventilation. Guidelines of the All-Russian public organization «Federation of Anesthesiologists and Reanimatologists». Russian Journal of Anaesthesiology and Reanimatology. 2022; 5: 6–17. DOI: 10.17116/anaesthesiology20220516 (In Russ)]
- FOOD Trial Collaboration. Poor nutritional status on admission predicts poor outcomes after stroke: observational data from the FOOD trial. Stroke. 2003; 34(6): 1450–6. DOI: 10.1161/01.STR.0000074037.49197.8C
- Soar J., Nolan J.P., Böttiger B.W., et al. Adult advanced life support section Collaborators. European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. Resuscitation. 2015; 95: 100–47. DOI: 10.1016/j.resuscitation.2015.07.016
- Хошбоняни П.А., Исмайлов И.С., Лейдерман И.Н. Ключевые проблемы при проведении нутритивной поддержки у пациентов с ишемическим инсультом и нетравматическим внутричерепным кровоизлиянием. Вопросы питания. 2020; 89 (5): 59–68. DOI: 10.24411/0042-8833-2020-10066 [Khoshbonyani P.A., Ismayilov I.S., Leyderman I.N. Key problems of nutritional support in patients with ischemic stroke and nontraumatic intracranial hemorrhage. Problems of Nutrition. 2020; 89 (5): 59–68. DOI: 10.24411/0042-8833-2020-10066 (In Russ)]
- Луфт В.М., Лапицкий А.В. Протоколы нутритивной поддержки больных в интенсивной терапии. Санкт-Петербург, 2017; 99. [Luft V.M., Lapitskii A.V. Protokoly nutritivnoi podderjki bol’nyh v intensivnoi terapii. Saint Petersburg, 2017; 99. (In Russ)]
- Sungurtekin H., Sungurtekin U., Oner O., et al. Nutrition assessment in critically ill patients. Nutrition in Clinical Practice. 2009; 23(6): 635–41. DOI: 10.1177/0884533608326137
- Kondrup J., Allison S.P., Elia M., et al. Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002. Clinical Nutrition. 2003; 22(4): 415–21. DOI: 10.1016/s0261-5614(03)00098-0
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