电邮这篇文章 Nutritional support for patients in the neurosurgical and neurological intensive care unit: are special guidelines necessary?
- 作者: Krylov K.I.1, Sviridov S.V.1, Savin I.A.2
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隶属关系:
- The Russian National Research Medical University named after N.I. Pirogov
- N.N. Burdenko National Scientific and Practical Center for Neurosurgery
- 期: 卷 2, 编号 3 (2021)
- 页面: 173-179
- 栏目: Editorial
- URL: https://journals.rcsi.science/2658-4433/article/view/105438
- DOI: https://doi.org/10.17816/clinutr105438
- ID: 105438
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The nutritional support for patients in the intensive care unit is an integral component of intensive care. Patients of a neurological and neurosurgical profile who are in the intensive care unit are a special group of patients, whose treatment differs both in the used intensive therapy methods and nutritional support provision.
Indirect calorimetry should be used to determine the energy requirements in neurosurgical and neurological patients. The use of calculation equations, such as the Harris-Benedict equation, is impossible due to its large discrepancy with indirect calorimetry data. The need for protein in patients of this category should be made at the rate of 1.2–2.0 g/kg of body weight per day. The urinary nitrogen loss data should not be used as a routine method for determining protein requirements in these patients. Insufficient energy and protein intake in neurosurgical and neurological patients can lead to increased infectious complications, mechanical ventilation duration, and length of intensive care unit stay, and rehabilitation potential deterioration. Excessive energy intake can lead to increased carbon dioxide production and intra-abdominal pressure, thereby increasing the intracranial pressure and aggravating secondary brain damage.
The central nervous system damage leads to increased intestinal permeability, worsens motility, and even changes the microbiota, which requires constant monitoring of the gastrointestinal tract functions to provide adequate nutritional support in neurological and neurosurgical patients who are in the intensive care unit.
In modern guidelines, both on intensive care and nutritional support, recommendations for its implementation in these patients are unclear.
作者简介
Kirill Krylov
The Russian National Research Medical University named after N.I. Pirogov
编辑信件的主要联系方式.
Email: kkrylov@nsi.ru
ORCID iD: 0000-0002-1807-7546
SPIN 代码: 9435-0854
MD, Cand. Sci. (Med.), Associate professor department anaesthesiology, reanimatology and intensive care medical Faculty, Senior Researcher Intensive Care Unit, Federation Senior Researcher
俄罗斯联邦, 1, Ostrovityanova street, Moscow, 117997Sergey Sviridov
The Russian National Research Medical University named after N.I. Pirogov
Email: sergey.sviridov.59@mail.ru
ORCID iD: 0000-0002-9976-8903
SPIN 代码: 4974-9195
MD, Dr. Sci. (Med.), Professor
俄罗斯联邦, 1, Ostrovityanova street, Moscow, 117997Ivan Savin
N.N. Burdenko National Scientific and Practical Center for Neurosurgery
Email: savin@nsi.ru
ORCID iD: 0000-0003-2594-5441
SPIN 代码: 1342-7065
MD, Dr. Sci. (Med.), Assistant Professor, Professor
俄罗斯联邦, Moscow参考
- Singer P, Blaser RA, Berger M, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clinical Nutrition. 2018;38(1): 48–79. doi: 10.1016/j.clnu.2018.08.037
- McClave SA, Beth E, Martindale TG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically Ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). J Parenteral Enteral Nutrition. 2016;40(2):159–211. doi: 10.1177/0148607115621863
- Clinical recommendations “Metabolic monitoring and nutritional support during long-term artificial lung ventilation” (approved in 2017). Federation of Anesthesiologists-Resuscitators; 2017. 33 p. (In Russ).
- Burgos R, Bretón I, Cereda E, et al. ESPEN guideline clinical nutrition in neurology. Clin Nutr. 2018;37(1):354–396. doi: 10.1016/j.clnu.2017.09.003
- Bansal V, Costantini T, Kroll L, et al. Traumatic brain injury and intestinal dysfunction: uncovering the neuro-enteric axis. J Neurotrauma. 2009;26(8):1353–1359. doi: 10.1089/neu.2008.0858
- Olsen AB, Hetz RA, Xue H, et al. Effects of traumatic brain injury on intestinal contractility. Neurogastroenterol Motil. 2013;25(7): 593–e463. doi: 10.1111/nmo.12121
- Swidsinski A, Loening-Baucke V, Krüger M, Kirsch S. Central nervous system and the colonic bioreactor: analysis of colonic microbiota in patients with stroke unravels unknown mechanisms of the host defense after brain injury. Intestinal Research. 2012;10(4):332–342. doi: 10.5217/ir.2012.10.4.332
- Carney N, Totten A, O’Reilly C, et al. Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery. 2016;80(1):6–15. doi: 10.1227/NEU.0000000000001432
- Scerrati A, de Rosa S, Mongardi L, et al. Standard of care, controversies, and innovations in the medical treatment of severe traumatic brain injury. J Neurosurg Sci. 2018;62(5):574–583. doi: 10.23736/S0390-5616.18.04462-4
- Connolly ES, Rabinstein AA, Carhuapoma JR, et al.; American Heart Association Stroke Council; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; Council on Cardiovascular Surgery and Anesthesia; Council on Clinical Cardiology. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association / American Stroke Association. Stroke. 2012;43(6):1711–1737. doi: 10.1161/STR.0b013e3182587839
- Hemphill JC, Greenberg SM, Anderson CS, et al.; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals from the American Heart Association / American Stroke Association. Stroke. 2015;46(7):2032–2060. doi: 10.1161/STR.0000000000000069
- Grasso G, Alafaci C, Macdonald RL. Management of aneurysmal subarachnoid hemorrhage: state of the art and future perspectives. Surg Neurol Int. 2017;8:11. doi: 10.4103/2152-7806.198738
- Powers WJ, Rabinstein AA, Ackerson T, et al.; American Heart Association Stroke Council. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49(3):e46–e99. doi: 10.1161/STR.0000000000000158
- Blaser RA, Starkopf J, Alhazzani W, et al.; ESICM Working Group on Gastrointestinal Function. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med. 2017;43(3):380–398. doi: 10.1007/s00134-016-4665-0
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