Nutritional support as part of the basic therapy of a patient in the acute period of ischemic stroke in the intensive care unit

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Abstract

Ischemic stroke remains the predominant cause of disability in the population (3.2 per 1000 population). Only 8% of ischemic stroke survivors can return to their previous work. Nutritional support is an integral part of the multidisciplinary approach to the treatment of ischemic stroke in the intensive care unit during the acute and rehabilitation phases. Brain damage always has metabolic consequences on the patient’s body, and premorbid malnutrition and stroke-stroke malnutrition significantly affect disease outcomes. The incidence of malnutrition in patients with ischemic stroke varies widely, ranging from 6.1% to 62%, depending on the method for determining protein-energy malnutrition. Despite the relevance of the problem of nutritional support in patients with ischemic stroke, only a few specific recommendations are available in the literature for this category of patients. This review focuses on nutritional support for patients who require mechanical ventilation or admission in the intensive care unit for >48 h.

About the authors

Kirill Yu. Krylov

Pirogov Russian National Research Medical University; N.N. Burdenko National medical research center of neurosurgery

Author for correspondence.
Email: kkrylov@nsi.ru
ORCID iD: 0000-0002-1807-7546
SPIN-code: 9435-0854

MD, Cand Sci. (Med.)

Russian Federation, Moscow; Moscow

Sergey V. Sviridov

Pirogov Russian National Research Medical University

Email: sergey.sviridov.59@mail.ru
ORCID iD: 0000-0002-9976-8903
SPIN-code: 4974-9195

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

Irina V. Vedenina

Pirogov Russian National Research Medical University

Email: viv54@mail.ru
ORCID iD: 0000-0002-1232-6767
SPIN-code: 6199-6980

MD, Cand Sci. (Med.), Associate Professor

Russian Federation, Moscow

Ruben S. Yagubyan

Pirogov Russian National Research Medical University

Email: kkrylov@nsi.ru
ORCID iD: 0000-0003-3273-890X
SPIN-code: 5617-6196

MD

Russian Federation, Moscow

References

  1. Medical and demographic indicators of the Russian Federation. 2012: statistical materials. Moscow; 2013. 180 p. (In Russ).
  2. Akzhigitov RG, Alekyan BG, Alferova VV, et al. Ischemic stroke and transient ischemic attack in adults: clinical guidelines. Moscow; 2021. 260 p. (In Russ).
  3. Donnan GA, Dewey HM. Stroke and nutrition: FOOD for thought. Lancet. 2005;365(9461):729–730. doi: 10.1016/S0140-6736(05)17996-3
  4. Rowat A. Enteral tube feeding for dysphagic stroke patients. Br J Nurs. 2015;24(3):138–145. doi: 10.12968/bjon.2015.24.3.138
  5. Bouziana SD, Tziomalos K. Malnutrition in patients with acute stroke. J Nutr Metab. 2011:167898. doi: 10.1155/2011/167898
  6. Corrigan ML, Escuro AA, Celestin J, Kirby DF. Nutrition in the stroke patient. Nutr Clin Pract. 2011;26(3):242–252. doi: 10.1177/0884533611405795
  7. Davis JP, Wong AA, Schluter PJ, et al. Impact of premorbid undernutrition on outcome in stroke patients. Stroke. 2004;35(8): 1930–1934. doi: 10.1161/01.STR.0000135227.10451.c9
  8. Dávalos A, Ricart W, Gonzalez-Huix F, et al. Effect of malnutrition after acute stroke on clinical outcome. Stroke. 1996;27(6):1028–1032. doi: 10.1161/01.str.27.6.1028
  9. Compan B, di Castri A, Plaze JM, Arnaud-Battandier F. Epidemiological study of malnutrition in elderly patients in acute, sub-acute and long-term care using the MNA. J Nutr Health Aging. 1999;3(3):146–151.
  10. Axelsson K, Asplund K, Norberg A, Alafuzoff I. Nutritional status in patients with acute stroke. Acta Med Scand. 1988;224(3):217–224. doi: 10.1111/j.0954-6820.1988.tb19364.x
  11. Choi-Kwon S, Yang YH, Kim EK, et al. Nutritional status in acute stroke: undernutrition versus overnutrition in different stroke subtypes. Acta Neurol Scand. 1998;98(3):187–192. doi: 10.1111/j.1600-0404.1998.tb07292.x
  12. Foley NC, Salter KL, Robertson J, et al. Which reported estimate of the prevalence of malnutrition after stroke is valid? Stroke. 2009;40(3):e66–74. doi: 10.1161/STROKEAHA.108.518910
  13. Gariballa SE, Parker SG, Taub N, Castleden CM. Influence of nutritional status on clinical outcome after acute stroke. Am J Clin Nutr. 1998;68(2):275–281. doi: 10.1093/ajcn/68.2.275
  14. Finestone HM, Greene-Finestone LS, Wilson ES, Teasell RW. Malnutrition in stroke patients on the rehabilitation service and at follow-up: prevalence and predictors. Arch Phys Med Rehabil. 1995;76(4):310–316. doi: 10.1016/s0003-9993(95)80655-5
  15. Unosson M, Ek AC, Bjurulf P, von Schenck H, Larsson J. Feeding dependence and nutritional status after acute stroke. Stroke. 1994;25(2):366–371. doi: 10.1161/01.str.25.2.366
  16. Foley NC, Martin RE, Salter KL, Teasell RW. A review of the relationship between dysphagia and malnutrition following stroke. J Rehabil Med. 2009;41(9):707–713. doi: 10.2340/16501977-0415
  17. Chai J, Chu FC, Chow TW, Shum NC. Prevalence of malnutrition and its risk factors in stroke patients residing in an infirmary. Singapore Med J. 2008;49(4):290–296.
  18. Lieber AC, Hong E, Putrino D, et al. Nutrition, Energy Expenditure, Dysphagia, and Self-Efficacy in Stroke Rehabilitation: A Review of the Literature. Brain Sci. 2018;8(12):218. doi: 10.3390/brainsci8120218
  19. Kondrup J, Allison SP, Elia M, et al.; Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22(4):415–421. doi: 10.1016/s0261-5614(03)00098-0
  20. Cederholm T, Jensen GL, Correia MITD, et al.; GLIM Core Leadership Committee; GLIM Working Group. GLIM criteria for the diagnosis of malnutrition — A consensus report from the global clinical nutrition community. Clin Nutr. 2019;38(1):1–9. doi: 10.1016/j.clnu.2018.08.002
  21. Kondrup J. Nutritional-risk scoring systems in the intensive care unit. Curr Opin Clin Nutr Metab Care. 2014;17(2):177–182. doi: 10.1097/MCO.0000000000000041
  22. Canales C, Elsayes A, Yeh DD, et al. Nutrition Risk in Critically Ill Versus the Nutritional Risk Screening 2002: Are They Comparable for Assessing Risk of Malnutrition in Critically Ill Patients? JPEN J Parenter Enteral Nutr. 2019;43(1):81–87. doi: 10.1002/jpen.1181
  23. Singer P, Blaser AR, Berger MM, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38(1):48–79. doi: 10.1016/j.clnu.2018.08.037
  24. Heyland DK, Dhaliwal R, Jiang X, Day AG. Identifying critically ill patients who benefit the most from nutrition therapy: the development and initial validation of a novel risk assessment tool. Crit Care. 2011;15(6):R268. doi: 10.1186/cc10546
  25. Rahman A, Hasan RM, Agarwala R, et al. Identifying critically-ill patients who will benefit most from nutritional therapy: Further validation of the “modified NUTRIC” nutritional risk assessment tool. Clin Nutr. 2016;35(1):158–162. doi: 10.1016/j.clnu.2015.01.015
  26. 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
  27. Bardutzky J, Georgiadis D, Kollmar R, Schwab S. Energy expenditure in ischemic stroke patients treated with moderate hypothermia. Intensive Care Med. 2004;30(1):151–154. doi: 10.1007/s00134-003-1988-4
  28. Bardutzky J, Georgiadis D, Kollmar R, et al. Energy demand in patients with stroke who are sedated and receiving mechanical ventilation. J Neurosurg. 2004;100(2):266–271. doi: 10.3171/jns.2004.100.2.0266
  29. Finestone HM, Greene-Finestone LS, Foley NC, Woodbury MG. Measuring longitudinally the metabolic demands of stroke patients: resting energy expenditure is not elevated. Stroke. 2003;34(2): 502–507. doi: 10.1161/01.str.0000053031.12332.fb
  30. Weekes E, Elia M. Resting energy expenditure and body composition following cerebro-vascular accident. Clin Nutr. 1992; 11(1):18–22. doi: 10.1016/0261-5614(92)90058-x
  31. Kawakami M, Liu M, Wada A, et al. Resting Energy Expenditure in Patients with Stroke during the Subacute Phases — Relationships with Stroke Types, Location, Severity of Paresis, and Activities of Daily Living. Cerebrovasc Dis. 2015;39(3-4):170–175. doi: 10.1159/000375155
  32. Leone A, Pencharz PB. Resting energy expenditure in stroke patients who are dependent on tube feeding: a pilot study. Clin Nutr. 2010;29(3):370–372. doi: 10.1016/j.clnu.2009.10.006
  33. Houdijk H, ter Hoeve N, Nooijen C, et al. Energy expenditure of stroke patients during postural control tasks. Gait Posture. 2010;32(3):321–326. doi: 10.1016/j.gaitpost.2010.05.016
  34. Serra MC, Treuth MS, Hafer-Macko CE, Ryan AS. Increased Energy Cost of Mobility in Chronic Stroke. J Gerontol Geriatr Res. 2016;5(6):356. doi: 10.4172/2167-7182.1000356
  35. Leiderman IN, Gritsan AI, Zabolotskikh IB, et al. Metabolic monitoring and nutritional support following long-term mechanical ventilation. Russian Journal of Anaesthesiology and Reanimatology. 2022;(5):6–17. (In Russ). doi: 10.17116/anaesthesiology20220516
  36. Brunner CS. Neurologic impairment. In: Matarese LE, Gottschlich MM, editors. Contemporary Nutrition Support Practice: A Clinical Guide. 2nd ed. St. Louis, MO: Saunders; 2003. P:384–395.
  37. Ha L, Hauge T, Iversen PO. Body composition in older acute stroke patients after treatment with individualized, nutritional supplementation while in hospital. BMC Geriatr. 2010;10:75. doi: 10.1186/1471-2318-10-75
  38. González-Fernández M, Ottenstein L, Atanelov L, Christian AB. Dysphagia after Stroke: an Overview. Curr Phys Med Rehabil Rep. 2013;1(3):187–196. doi: 10.1007/s40141-013-0017-y
  39. Martino R, Foley N, Bhogal S, et al. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005; 36(12):2756–2763. doi: 10.1161/01.STR.0000190056.76543.eb
  40. Stroud M, Duncan H, Nightingale J; British Society of Gastroenterology. Guidelines for enteral feeding in adult hospital patients. Gut. 2003;52(Suppl. 7):vii1–vii12. doi: 10.1136/gut.52.suppl_7.vii1
  41. National Collaborating Centre for Acute Care. Nutrition support in adults. Oral nutrition support, enteral tube feeding and parenteral nutrition. London: NICE; 2006. 176 p.
  42. Blumenstein I, Shastri YM, Stein J. Gastroenteric tube feeding: techniques, problems and solutions. World J Gastroenterol. 2014;20(26):8505–8524. doi: 10.3748/wjg.v20.i26.8505
  43. Stavroulakis T, Baird WO, Baxter SK, et al. The impact of gastrostomy in motor neurone disease: challenges and benefits from a patient and care perspective. BMJ Support Palliat Care. 2016;6(1):52–59. doi: 10.1136/bmjspcare-2013-000609
  44. Perry L. Eating and dietary intake in communication-impaired stroke survivors: a cohort study from acute-stage hospital admission to 6 months post-stroke. Clin Nutr. 2004;23(6):1333–1343. doi: 10.1016/j.clnu.2004.04.009
  45. Nip WF, Perry L, McLaren S, Mackenzie A. Dietary intake, nutritional status and rehabilitation outcomes of stroke patients in hospital. J Hum Nutr Diet. 2011;24(5):460–469. doi: 10.1111/j.1365-277X.2011.01173.x
  46. Foley N, Finestone H, Woodbury MG, et al. Energy and protein intakes of acute stroke patients. J Nutr Health Aging. 2006;10(3):171–175.

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