Vol 3, No 4 (2022)

BACKGROUND: Nutritional support in abdominal surgery is a complex aspect of intensive care with many contradictions in available recommendations and in relation to interdisciplinary interaction. The challenges of assessing nutritional status and timing of the start and methods of clinical nutrition have not yet been resolved. Research has not yet explained whom and how to feed in the intensive care unit, nor has it proved the need for an early start of enteral nutrition or assessed the scale of the problems, such as the lack of uniform views and low adherence to clinical recommendations.

AIM: To analyze the effectiveness of early enteral nutrition in achieving optimal treatment results in patients with abdominal surgical pathology and assess the depth of knowledge and adherence to clinical recommendations of specialists providing care to this cohort.

MATERIALS AND METHODS: The study included 50 patients, 32 of whom started early enteral nutrition and 18 received later enteral nutrition. A survey of 41 specialists (surgeons and intensivists) from three leading hospitals in Tyumen was also conducted. The main set of clinical material was conducted on the basis of the Regional Clinical Hospital No. 1 (Tyumen).

RESULTS: The study demonstrated the advantages of early enteral nutrition over delayed nutrition by an average of 48 h by reducing the length of hospital stay and resuscitation stage of treatment and minimizing pulmonary complications. Moreover, a survey of specialists assisting this cohort showed a lack of consensus in treatment approaches and insufficient adherence of patients with abdominal surgical pathology to existing clinical recommendations on clinical nutrition.

CONCLUSIONS: Further research on nutritional support in patients with abdominal surgical pathology should aim at reducing the decision-making time in favor of an earlier and combined method of nutritional support, which can be facilitated by enhancing literacy and promoting adherence to clinical recommendations of specialists at the interdisciplinary level.

This study further discussed the 2021 ESPEN practical recommendations for nutritional support in oncology. The updated version of the 2021 ESPEN practice guidelines differs slightly from the 2017 version and contains flowcharts to facilitate the use of the guidelines in clinical practice, which is also relevant for domestic healthcare. ESPEN-2021 Clinical Guidelines, which offer practical solutions in all areas of oncology, are significant to both oncologists and allied specialists working in oncology. The second part of the review discusses particular issues of nutritional support for patients with cancer and analyzes the domestic experience of their use. The review provides the main protocols for artificial nutrition in surgery, during irradiation, and in drug therapy in patients in remission and at the palliative stage and proves the need to maintain physical activity in patients with cancer. The presented practical guidance allows organizing an adequate supply of nutrient substrates to patients with cancer receiving various types of anticancer treatment, in remission, and at the stage of palliative care.

This review presents meta-analyses on nutrition in patients with critical illness using ASPEN/SCCM (2017), SSC (2012, 2021), ESPNIC (2020), and SSC (2020) pediatric sepsis guidelines. The ESPNIC (2020) guideline, based on new evidence, complements most of the existing ASPEN (2017) guidelines for critical pediatrics. Children’s SSC (2020) did not find direct evidence and sufficient data to develop strong nutritional recommendations for children with sepsis/SS. Many issues remain unresolved, requiring systematic analysis. In the literature search, only a few randomized clinical trials have focused on the assessment and correction of protein-energy malnutrition in pediatric intensive care. Over the past decade, small and large pediatric studies have recommended nutritional therapy. However, given the heterogeneity of children admitted to intensive care units in terms of age, pathology, disease severity, presence of comorbidities, and nutritional status, it is unrealistic to expect that one nutrition strategy applies to all patients requiring intensive care. Therefore, most clinicians emphasize the need for an individualized approach to nutrition support in children, taking into account the pathology, severity, initial nutritional status, and risk–benefit ratio of different nutritional therapies. An extensive search of the literature on the problem did not reveal strong nutritional recommendations for children with sepsis/SS, which dictates the need for future research on the topic and correction of protein-energy malnutrition in children with sepsis/SS.