Vol 2, No 4 (2021)

BACKGROUND: Selective craniocerebral hypothermia, used in the acute period of brain damage, ensures the development of positive clinical effects (rapid and persistent reduction of neurological deficit, increased consciousness, and maintenance of normothermy in feverish patients). The safety and efficacy of craniocerebral hypothermia in the acute period of cerebrovascular lesions prompted the use of craniocerebral cooling in patients with chronic disorders of consciousness. For this category of patients, the craniocerebral hypothermia technique has been developed, which requires careful study including its effect on overall metabolism.

AIMS: To determine the nature of the metabolic response to craniocerebral hypothermia procedures in patients in a vegetative state and minimal conscious state.

MATERIALS AND METHODS: A pilot study was conducted from February 3, 2021 until March 3, 2022. This study included 34 patients who were in a state of chronic disorders of consciousness, CRS-R score of <8 (vegetative state and minimally conscious state), after severe brain damage (stroke, 25; brain injury, 5; anoxic brain injuries, 4). Hypothermia was induced using the ATG-01 device, lowering the temperature of the scalp to 4–7°C with a cooling procedure lasting for 120 min. The indirect calorimetry method was conducted before cooling and after 105 min of the craniocerebral hypothermia session. Statistical analysis was performed using the program StatTech v. 2.6.5 (StarTech LLC, Russia).

RESULTS: Craniocerebral cooling provided a decrease in the temperature of the frontal cortex of the large hemispheres already after 30 min from 36.4°C to 34.9±0.41°C in the left hemisphere and 34.7±0.47°C in the right hemisphere. By the 120th minute, the temperature in the left hemisphere reached 34.0±0.40°C, and that in the right hemisphere reached 33.3±0.51°C, decreasing by 2.4°C and 3.1°C, respectively. Subsequently, 30 min after the completion of craniocerebral hypothermia, the brain temperature remained lowered by 0.7°C. Changes in the level of metabolism under the influence of craniocerebral hypothermia were of a multidirectional nature. In 24 patients (70.59%), the resting energy expenditure (REE) index increased to varying degrees by the end of the cooling procedure, and in 10 participants, it decreased. A significant spread of data allowed only a descriptive analysis of the results obtained during a 120-min craniocerebral hypothermia session.

CONCLUSIONS: Chronic disorders of consciousness are largely associated with severe damage of the cerebral cortex. It can be assumed that in patients who reacted with a decrease in REE to the induction of hypothermia, at least metabolic activity in the intact parts of the cerebral cortex was preserved to a certain extent, which may indicate some level of rehabilitation potential. The lack of expression of the reactions of the general metabolism to craniocerebral cooling may be due to the fact that the severe damage to the cerebral cortex excluded the selectivity of hypothermic exposure.

The Coronavirus Disease 2019 (COVID-19) pandemic, declared by the World Health Organization on March 11, 2020, has made significant adjustments to the principles of organizing medical care, including treatment, nutrition, and care of patients in infectious hospitals. The disease has different clinical courses: from mild asymptomatic to extremely severe, requiring aggressive medical interventions, such as organ replacement therapy to replace vital body functions.

The spread of viral infection was global, but the pathophysiological aspects of the course of COVID-19 have not been studied comprehensively. The development of acute respiratory distress syndrome and systemic inflammatory response syndrome as part of the severe course of the disease is accompanied by severe metabolic disorders that require close attention. It is necessary to correct the clinical manifestations of organ dysfunction under severe hypercatabolism. Considerable importance is given to the peculiarities of providing nutritional support to patients using specialized nutritional mixtures to prevent conditions that worsen the prognosis of recovery and survival of patients.

The target cells of the virus are angiotensin-converting enzyme receptors of the respiratory, nervous, urinary, and cardiovascular systems and organs of the gastrointestinal tract. Consequently, the site of the infection at different organs and systems gives rise to the phenomena of respiratory failure and several heterogeneous clinical manifestations of the disease, which can affect all ties in the pathogenesis of nutritional deficiency. Malnutrition is usually due to the mismatch between the intake and consumption of nutrients, micro- and macroelements.

The causes for the imbalance of the intake-expenditure system can be divided into three groups: reduced nutrient intake, increased consumption due to hypercatabolism or hypermetabolism, and malabsorption and increased nutritional losses due to direct and indirect damages to the gastrointestinal tract. The division is traditional because, in the case of severe forms of coronavirus infection, there is always the presence of two or more factors leading to nutritional deficiencies.

In this study, we systematized the ways in which we provide nutritional support based on the prevalent causes of protein-energy malnutrition, taking into account the patient’s individual needs and the extent of respiratory support. Several articles published by foreign colleagues and our own experience in the Department of Anesthesiology and Intensive Care for Patients with a New Coronavirus Infection COVID-19 at the Russian Academy of Sciences Central Clinical Hospital in Moscow in 2020 were analyzed.

This study discusses in detail the problems and characteristics of clinical nutrition that a practicing intensive care specialist faces when enduring all possible measures to maintain the stable homeostasis of the patient.

Dear readers!

We are opening a new section of the magazine: “Interviews with leading experts” The rubric includes meetings with leading doctors of various specialties. For each such meeting, the interviewer makes a selection of the most frequently asked questions in clinical nutrition and metabolism.

The purpose of the rubric is to be acquainted with leading Russian specialists in their field but always attentive and reasonable people who do not make hasty conclusions because a profession aimed at preserving human life and improving its quality does not forgive mistakes.

Today, the guest of the editorial office is Doctor of Medical Sciences, Professor Andrey Ustinovich Lekmanov, a well-known and respected pediatric anesthesiologist-resuscitator in Russia with >50 years of experience, who was at the forefront of domestic pediatric anesthesiology and resuscitation. The topic of this discussion “Possibilities and prospects of clinical nutrition in pediatric anesthesiology and resuscitation” is directly related to the activities of Andrei Ustinovich, who pays great attention to the issues of clinical nutrition of the patient in the intensive care unit.

A conversation with Doctor of Medical Sciences, Professor Andrey Ustinovich Lekmanov was conducted by the editor-in-chief of the journal Clinical Nutrition and Metabolism, Sergey Viktorovich Sviridov.

It is generally accepted that the growth of the skeletal muscles and retention of the muscle mass throughout life depend mainly on the amount of protein of animal origin consumed with food. The difference between the effect of animal and plant proteins on muscle mass has recently been studied by several authors. However, when considering this topic, researchers often make gross, in our opinion, mistakes that make it difficult to further study this topic.

Is the clear differentiation that has always been made between animal proteins and plant proteins necessary? Can we say that the differences between protein sources are minimal and perhaps even nonexistent? In this review, we considered studies on this topic and the effect of protein supplements of various origins and quality and their dosages on muscle mass and strength.