Vol 1, No 1 (2020)

Interview with Vice President of the Russian Association of Parenteral and Enteral Nutrition Professor T. S. Popova is devoted to the topic of nutritional deficiency associated with diseases, trauma and surgical interventions, as well as the inclusion of nutritional support in all treatment standards in inpatient and outpatient stages. The questions of raising the level of doctors’ training and promising areas in the science of nutrition are considered.

Background. Nutritional support is an important part of the treatment of critically ill patients. However, there are no specific recommendations for patients in a long unconscious state after brain damage to determine their energy needs.

Aim. To determine the role of indirect calorimetry in assessing the energy expenditure of patients in prolonged unconsciousness after brain damage.

Methods. Prospective cohort study included 81 patients with brain damage who were treated in the intensive care unit. All patients with prolonged unconsciousness had stayed in the intensive care unit for more than 30 days. Mean age of patients was 48.4 ± 16.3 years. Men were predominant (58%). Almost all patients had normal body mass index (BMI) (mean 22.8 ± 6.2 kg/m²). The main cause of brain damage was severe traumatic injury (42%). There were also patients with consequences of subarachnoid hemorrhage (35%), stroke (19%) and hypoxic damage (4%).

Results. According to indirect calorimetry, mean energy requirements in patients in prolonged unconsciousness was 25.12 ± 8.8 kcal/kg/day (1595.3 ± 560 kcal/day). Variability of this value was high in this sample (10.6–61.6 kcal/kg/day, 673–3514 kcal/day). According to urine nitrogen loss, mean protein requirement was 0.83 ± 0.46 g/kg/day that was lower than the recommended values for critically ill patients. Variability of data obtained by indirect calorimetry was higher than that of the calculated values despite statistically similar energy requirements of patients. Variability of data obtained by Harris-Benedict equation ranged from 15.4 kcal/kg/day (1023 kcal/day) to 37.3 kcal/kg/day (2065 kcal/day). There was no relationship between energy expenditure and causes of brain damage. Moreover, significant correlation between metabolic rate, urine nitrogen loss and outcomes of disease was also absent.

Conclusion. Indirect calorimetry alone is not enough to prescribe optimal nutritional support in patients with prolonged unconsciousness if function of the gastrointestinal tract and other factors affecting energy expenditure are not considered.

It has been established that HIV-infection is associated with progressive deficiency of L-glutamine followed by immune dysfunction, reduced body mass and muscle strength, morphological disorders and functional disintegration of the intestine, as well as neurological disorders. According to current ideas, correction of L-glutamine deficiency is one of the important components of adjuvant therapy for HIV-infected patients within general nutritional support strategy. This measure helps to slow development of AIDS, reduce side effects of antiretroviral therapy and enhance effectiveness.

Bullous epidermolysis is a congenital disease characterized by skin vulnerability due to the formation of blisters and erosion on the skin and mucous membranes, which makes it difficult for a child to eat naturally. The problem of providing the necessary nutrients to children with this serious illness remains relevant. The article shows its own clinical experience in the use of modern enteral nutritional mixtures in a child with epidermolysis bullosa. Given the skin manifestations, the possibility of infection of the catheter for prolonged parenteral nutrition, children with bullous epidermolysis are not recommended for prolonged use of parenteral nutrition, so the use of modern mixtures for enteral nutrition remains the method of choice.