Clinical nutrition and metabolism

BACKGROUND: Adequate compensation for protein-energy losses and timely correction of metabolic disorders are key components of intensive care for critically ill patients. Currently, nutritional support (NS) is regarded as an essential component of intensive care for critically ill patients, as it helps reduce the incidence of infectious complications, shorten the duration of hospitalization, lower treatment costs, and improve survival rates. However, the practical implementation of NS in the intensive care unit (ICU) setting is associated with various organizational challenges and requires specific professional knowledge and skills to minimize the risk of technical and metabolic complications.

AIM: The work aimed to assess the theoretical knowledge and practical skills of anesthesiologists–intensivists in providing NS to patients in ICUs of healthcare institutions in the Russian Federation.

METHODS: This multicenter cross-sectional observational study was conducted via an anonymous remote survey. A total of 121 certified anesthesiologists-intensivists actively working in ICUs participated between September 4 and September 18, 2018. The survey evaluated physician adherence to NS practices, the frequency of monitoring protein-energy balance, the level of knowledge regarding NS, and the impact of material and technical resources on its effectiveness. Data were analyzed by comparing responses among three groups of participants.

RESULTS: In current clinical practice, anesthesiologists-intensivists employ various methods to assess patients’ nutritional status, although none are universally accepted. According to the data obtained, not all physicians routinely assess patients’ protein and energy needs—such assessments are conducted by 80% and 72% of respondents, respectively. A significant issue identified was the insufficient provision of ICU equipment for administering NS. One-third of respondents rated the availability of specialized formulas for parenteral and enteral nutrition in their hospitals as unsatisfactory. Notably, the vast majority of respondents (98%) expressed a desire to improve their knowledge in the field of NS, indicating the high relevance of this topic within the professional community.

CONCLUSION: The study revealed that many practicing physicians often lack sufficient theoretical knowledge regarding the practical implementation of NS. The material and technical support in ICUs remains unsatisfactory, with a shortage of nutritional formulas and equipment necessary for the adequate administration of enteral and parenteral nutrition.

Various electrolyte imbalances, including changes in magnesium levels, are characteristic of critically ill patients. However, routine measurement of magnesium concentration is often omitted, which may result in the development of hypomagnesemia.

We conducted a review of the medical scientific data on this issue to present the current state of knowledge.

To address the stated objectives, a scientific data search was performed in the eLIBRARY.RU and PubMed databases covering the period from 1975 to 2024. Articles in English and Russian were analyzed using the following keywords: “hypomagnesemia”, “electrolyte imbalance”, “potassium”, “sodium”, and “intensive care unit”. Full-text articles describing hypomagnesemia in critically ill adult patients in the general population, excluding obstetric conditions, were included in the analysis.

The results of the analysis showed that in this patient category, hypomagnesemia is associated with increased mortality, higher incidence of sepsis, prolonged mechanical ventilation, longer hospital stays, and elevated one-year post-discharge mortality rates. In this regard, routine magnesium assessment should be mandatory for intensive care unit patients with gastrointestinal, endocrine, and cardiovascular diseases, as well as with acute kidney injury or exacerbation of chronic kidney disease. Further research is required to clarify the therapeutic role of magnesium in improving outcomes for critically ill patients.

BACKGROUND: Following neoadjuvant chemotherapy (NACT), patients with esophageal cancer may develop severe functional impairments that render radical surgical intervention impossible. We present a clinical case of severe functional deficiency that developed in a patient with esophageal cancer during NACT, necessitating comprehensive medical rehabilitation prior to radical surgical intervention.

Case description: A 75-year-old male was diagnosed with adenocarcinoma of the distal esophagus, stage cT3N0M0 (stage II). He received four cycles of antitumor therapy using the FLOT regimen (fluorouracil, calcium folinate, oxaliplatin, docetaxel), with a positive response. Radical surgical treatment was indicated; however, severe functional decline combined with metabolic disturbances precluded the procedure. A multimodal medical rehabilitation program, including therapeutic exercise, limb massage, nutritional support, and correction of metabolic and fluid-electrolyte imbalances, enabled clinical stabilization of patient within a short period.

CONCLUSION: Given the multifaceted nature of functional impairments in patients with esophageal cancer, medical rehabilitation should be based on multimodal programs incorporating symptomatic drug therapy. This approach appears to be optimal in this patient cohort.