Clinical nutrition and metabolismClinical nutrition and metabolismКлиническое питание и метаболизм2658-44332782-2974Eco-Vector10562510.17816/clinutr105625ReviewsНаучные обзорыReview ArticleMetabolic predictors of life-threatening conditions in patients in chronic critical illnessМетаболические предикторы жизнеугрожающих состояний у больных в хроническом критическом состоянииhttps://orcid.org/0000-0002-5278-70587531-6925ShestopalovAlexandr E.ШестопаловАлександр Ефимович
Russian Federation

MD, Dr. Sci. (Med.), Professor

д.м.н., профессор

ashest@yandex.ruhttps://orcid.org/0000-0001-9903-72573133-3281YakovlevaAlexandra V.ЯковлеваАлександра Витальевна
Russian Federation
avyakovleva@fnkcrr.ruhttps://orcid.org/0000-0003-4995-2443LukyanetsOleg B.ЛукьянецОлег Борисович
Russian Federation
olukyanec@fnkcrr.ruhttps://orcid.org/0000-0003-4272-09579132-4190PetrovaMarina V.ПетроваМарина Владимировна
Russian Federation

MD, Dr. Sci. (Med.)

д.м.н.

mpetrova@fnkcrr.ruFederal Research and Clinical Center of Intensive Care Medicine and RehabilitologyФедеральный научно-клинический центр реаниматологии и реабилитологииRussian Medical Academy of Continuous Professional EducationРоссийская медицинская академия непрерывного профессионального образованияPeoples’ Friendship University of RussiaРоссийский университет дружбы народов23052022070620223138492903202219052022Copyright ©; 2022, Shestopalov A.E., Yakovleva A.V., Lukyanets O.B., Petrova M.V.Copyright ©; 2022, Шестопалов А.Е., Яковлева А.В., Лукьянец О.Б., Петрова М.В.2022Shestopalov A.E., Yakovleva A.V., Lukyanets O.B., Petrova M.V.Шестопалов А.Е., Яковлева А.В., Лукьянец О.Б., Петрова М.В.https://creativecommons.org/licenses/by/4.0https://journals.eco-vector.com/2658-4433/article/view/105625

Due to modern advances in medicine, more and more patients survive after severe acute diseases. However, some such patients remain dependent on life-support systems. Therefore, a chronic critical condition is an urgent problem for patients in the intensive care unit. The main syndrome of this complex is maladaptive responses to long-term existing stress factors. This review examines the main pathophysiological mechanisms of chronic critical illness, as well as the resulting metabolic disorders. A literature search was conducted in the English-language databases of medical and biological publications PubMed and Scopus, as well as the Russian bibliographic system RSCI. The coverage interval was the last 20 years. Emphasis was placed on the systemic inflammatory reaction; the reaction of hypermetabolism-hypercatabolism; disorders of carbohydrate, protein, and fat metabolism; and the development of secondary sarcopenia. In conclusion, the volume of metabolic control and intensive nutritional and metabolic support, which are critical components of a comprehensive approach to the treatment of chronic critical illness, are key considerations considered.

Благодаря современному уровню развития медицины всё больше пациентов выживает после тяжёлых острых заболеваний. Однако при этом часть пациентов остаётся зависимой от систем жизнеобеспечения. Поэтому хроническое критическое состояние является актуальной проблемой пациентов отделения интенсивной терапии. Основой данного синдромокомплекса является дезадаптивная реакция на длительно существующие стрессовые факторы. В данном обзоре рассмотрены основные патофизиологические механизмы хронического критического состояния, а также развивающиеся вследствие этого метаболические нарушения. Проведен литературный поиск в англоязычной текстовой базе данных медицинских и биологических публикаций PubMed, Scopus, а также российской библиографической системе РИНЦ. Интервал охвата — последние 20 лет. Акценты сделаны на системной воспалительной реакции, реакции гиперметаболизма-гиперкатаболизма, нарушениях углеводного, белкового и жирового обмена, развитии вторичной саркопении. В заключение также рассмотрены объём метаболического контроля и интенсивная нутритивно-метаболическая поддержка, являющаяся важной составляющей комплексного подхода к терапии хронического критического состояния.

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