Роль нутритивной поддержки при физической и функциональной реабилитации пациентов в критическом состоянии

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Аннотация

Отсутствие положительных результатов рандомизированных контролируемых исследований привело к серьёзным спорам относительно роли питания во время критического заболевания с точки зрения долгосрочных исходов. Несмотря на то, что невозможность адекватно оценить все биологические механизмы, связанные с питанием, может частично объяснить отсутствие положительных результатов исследований, следует признать, что нутритивная поддержка во время ранней фазы критического заболевания, если её рассматривать отдельно от остального лечения, может иметь весьма ограниченное долгосрочное функциональное значение.

В настоящем обзоре особое внимание уделяется недавним клиническим исследованиям по оценке влияния питания в критическом состоянии на долгосрочное физическое и функциональное восстановление.

Подробно рассмотрены конкретные варианты дизайна исследования и методологические ограничения. Ограничения включают в себя достижение целевых показателей калорийности и белка, неоднородность пациентов, короткую продолжительность интервенции, несоответствующие клинические исходы и отсутствие должного внимания к исходному нутритивному статусу в период после перевода из отделения интенсивной терапии. Поскольку выживаемость является ключевым моментом исследований в сфере интенсивной терапии, крайне важно, чтобы при разработке дизайна исследований в области питания тщательно рассматривались все биологические механизмы, связанные с нутритивной поддержкой, поскольку эти факторы могут сильно влиять на полученные результаты, в частности долгосрочные физические и функциональные исходы. Отсутствие должного внимания к механизмам нутритивной поддержки может привести к провалу клинических испытаний и, как следствие, отказу от потенциально полезных эффектов нутритивного вмешательства в период критического состояния.

Настоящая статья является русскоязычным переводом оригинальной публикации Bear D.E. и соавторов “The role of nutritional support in the physical and functional recovery of critically ill patients: a narrative review” в журнале Critical Care [2017;21(1):226. doi: 10.1186/s13054-017-1810-2], выполненным с разрешения правообладателей.

Об авторах

Danielle E. Bear

Guy’s and St Thomas’ NHS Foundation Trust; King’s College London

Email: cnm@eco-vector.com

Department of Nutrition and Dietetics, Department of Critical Care, Division of Asthma, Allergy, and Lung Biology, National Institute for Health Research (NIHR), Biomedical Research Centre, Lane Fox Clinical Respiratory Physiology Research Centre

Великобритания, Лондон; Лондон

Liesl Wandrag

Guy’s and St Thomas’ NHS Foundation Trust

Email: cnm@eco-vector.com

Department of Nutrition and Dietetics, Department of Critical Care

Великобритания, Лондон

Judith L. Merriweather

University of Edinburgh; Royal Infirmary of Edinburgh

Email: cnm@eco-vector.com

Anaesthesia, Critical Care and Pain Medicine

Великобритания, Эдинбург; Эдинбург

Bronwen Connolly

Guy’s and St Thomas’ NHS Foundation Trust; King’s College London; The University of Melbourne

Автор, ответственный за переписку.
Email: cnm@eco-vector.com

National Institute for Health Research (NIHR), Biomedical Research Centre, Lane Fox Clinical Respiratory Physiology Research Centre, Centre for Human and Aerospace Physiological Sciences, Department of Physiotherapy

Великобритания, Лондон; Лондон; Melbourne, штат Виктория, Австралия

Nicholas Hart

King’s College London; Guy’s and St Thomas’ NHS Foundation Trust

Email: cnm@eco-vector.com

Division of Asthma, Allergy, and Lung Biology, National Institute for Health Research (NIHR), Biomedical Research Centre, Lane Fox Clinical Respiratory Physiology Research Centre

Великобритания, Лондон; Лондон

Michael P. W. Grocott

University of Southampton; Southampton NIHR Biomedical Research Centre; University Hospital Southampton NHS Foundation Trust

Email: cnm@eco-vector.com

Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Respiratory and Critical Care Research Theme, Anaesthesia and Critical Care Research Unit

Великобритания, Саутгемптон; Саутгемптон; Саутгемптон

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