Clinical nutrition and metabolism

This review addresses the issue of protein-energy malnutrition and sarcopenia in patients with acute cerebral insufficiency admitted to intensive care units. Acute cerebral insufficiency is defined as a symptom complex characterized by various quantitative and qualitative disturbances of consciousness, disrupted coordination between afferent and efferent central nervous system activities. This leads to temporary or persistent impairment of physical or social functioning. Patients with acute cerebral insufficiency are of particular interest in terms of protein-energy malnutrition and sarcopenia, as diagnosing these conditions can be challenging due to pre-existing neurological deficits and prolonged intensive care unit stays common in this population. Additionally, factors such as population aging and increasing median age of intensive care unit patients increase the significance of protein-energy malnutrition and sarcopenia. Global data indicate that over half of intensive care unit patients are 65 years and older, with the fastest-growing subgroup comprising patients over 85 years old, who are often admitted in the intensive care unit already suffering from protein-energy malnutrition and sarcopenia or having an extremely high risk for their development. The increasing prominence of protein-energy malnutrition and sarcopenia in intensive care unit settings raises numerous questions about clinical interpretation and the best approaches to diagnosis, monitoring, and treatment of patients with acute cerebral insufficiency that meet the protein-energy malnutrition and sarcopenia criteria.

Background: Neurogenic dysphagia is a common swallowing impairment, particularly prevalent among patients who have suffered an ischemic stroke. This condition significantly increases the risk of aspiration pneumonia and heightens risks associated with protein-energy malnutrition and dehydration. Swallowing retraining through targeted therapeutic interventions is one of the primary approaches in managing patients with neurogenic dysphagia.

AIM: To evaluate the effectiveness of specialized nutritional formulas of varying viscosity in restoring swallowing function in patients with dysphagia at the acute phase of ischemic stroke as part of combined therapy.

Methods: The study enrolled 65 patients with acute cerebrovascular accident complicated by dysphagia. Patients were randomly assigned into two groups: experimental and control. The experimental group received specialized nutritional formulas of varying viscosity by Fresenius Kabi, whereas the control group received traditional nutrition. The severity of swallowing disorders and their progression were evaluated using the Penetration–Aspiration Scale (PAS) and the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS).

Results: Implementation of swallowing retraining in patients with ischemic stroke and dysphagia starting from Day 5 demonstrated superior recovery of swallowing function according to the PAS compared to the control group, with statistically significant differences by Day 10 (p=0.002). A similar trend was observed when evaluating swallowing using the FEDSS. On Day 10, the experimental group after ischemic stroke exhibited significantly improved dysphagia scores compared to the control group (p=0.002). Data from all 65 patients with acute ischemic stroke complicated by dysphagia indicated that specialized nutritional formulas accelerate the restoration of swallowing function compared with traditional nutrition. Marked improvement was noted as early as on Day 5 of treatment among patients receiving Fresenius Kabi high-viscosity formulas. No cases of aspiration pneumonia or progression of protein-energy malnutrition were recorded during the study.

Conclusion: Specialized nutritional formulas of varying viscosity as part of combined therapy significantly accelerate the recovery of swallowing function in patients with acute ischemic stroke, proving to be more effective than traditional nutritional approaches.

Background: Timely and successful treatment of chemotherapy-induced gastrointestinal toxicity ensures continued antitumor therapy in patients with cancer. Severe diarrhea can lead to dehydration and refusal of further cytostatic treatment. We present a clinical case of severe gastrointestinal toxicity requiring complex intensive therapy.

Case description: A 63-year-old male diagnosed with stage IV infiltrative ascending colon cancer with multiple liver metastases, T3N1M1, underwent four cycles of antitumor therapy following the FOLFOXIRI regimen (oxaliplatin, irinotecan, leucovorin, 5-fluorouracil) combined with bevacizumab, which was later discontinued due to thrombotic events. After the fifth cycle of FOLFOXIRI chemotherapy, grade 3 diarrhea developed, leading to dehydration and requiring complex intensive therapy, including TGF-β2-enriched enteral nutrition. The intervention was successful, enabling timely continuation of chemotherapy.

Conclusion: Considering the pathophysiology of drug-induced diarrhea, additional outpatient TGF-β2-enriched enteral nutrition should be recommended. This approach may reduce systemic disorders and aid in the prevention and rapid resolution of intestinal toxicity.