Perioperative infusion therapy

Perioperative infusion support of surgical patients is the main and non-alternative element of treatment. At the same time, the tactics of infusion therapy continues to be the subject of study. Ideas about the optimal quantitative and qualitative composition of the fluid transfused to patients are being revised as ideas about the pathogenesis of critical conditions evolve. The basis of pathogenetic analysis of compensatory hemodynamic capabilities, as a point of application of infusion treatment, previously consisted mainly of invasive monitoring techniques, replaced in recent years by the control of routine parameters with proven high correlation with invasive ones. In current studies devoted to the problems of infusion correction of hemodynamic abnormalities, the most discussed issues are the applicability of isotonic and balanced polyionic crystalloids, less often colloidal solutions in various clinical situations, and the results of such studies do not always allow to unambiguously determine the choice of infusion media, and sometimes simply incomparable. Some researchers advocate the use of isotonic crystalloids, some works prove the best effectiveness of balanced salt solutions. With the volumes of treatment corresponding to the perioperative period, in most studies there are no differences in the effectiveness of the main composite groups of crystalloids at all. We see the reason for this in the peculiarities of randomization methods, when statistical limitations do not allow us to avoid discrete data analysis: their comparative grouping occurs according to the principle of selecting a target parameter, and all the others are classified as auxiliary or secondary. It seems to us that the involvement of arrays of data obtained in real clinical practice as a result of a combination of local theoretical and empirical ideas about corrective treatment regimens correlated with their effectiveness could smooth out the inconsistency of the results of such studies, especially since clinicians have a sample with a volemic load at their disposal, allowing them to predict the hemodynamic reaction of the patient's body to infusion and a set of routine parameters for more fine-tuning of therapy.

The effect of early oral feeding after subtotal esophagectomy with immediate esophageal reconstruction on the patients’ nutritional status: randomized single-center study.

Background: The efficiency of early oral feeding (EOF) in the postoperative period is well known. Though in the esophagus surgery doctors still prefer another types of nutritional support after esophagectomy (EE) with immediate gastric tube reconstruction. Aims: to improve the results of patients treatment after EE with gastric tube reconstruction by choosing the method of nutritional support and to evaluate nutritional status of the patients with EOF. Materials and methods: weve conducted prospective single-center randomized study. Subtotal esophagectomy with immediate gastric tube reconstruction was performed to 60 patients. In the postoperative period we evaluated the results of treatment, the frequency and severity of complications, as well as anthropometric and laboratory indicators of the nutritional status before the operation, on 1, 3 and 6 postoperative day (POD). Results: Patients without high risk of malnutrition were randomly divided in 2 groups: main group (n=30) starting EOF on the 1 POD and control group (n=30) that remained nil by mouth and got parenteral feeding within 4 POD. The patients of EOF group had statistically significant earlier gas discharge (2[2;3] POD vs 4[3;6] POD, р = 0,000042) and stool appearance (3[2;4] POD vs 5[4;7] POD, р = 0,000004). There is a tendency of reduction of the duration of postoperative hospitalization in EOF group (8[7;9] POD vs 9[8;9] POD, р=0,13). EOF does not affect on frequency (46,6% vs 53,3%, р=0,66) and character of postoperative complications. After evaluation of the parameters of nutritional status we found statistically significant decrease of prealbumin level on 3 POD in EOF group (0,17 [0,13;0,21] vs 0,2 [0,16;0,34], р=0,03) of due to inability to compensate daily calorie needs in the first days after the operation. At 6 POD prealbumin became the same in both groups. There were no other significant differences between the groups. Conclusions: EOF after EE with immediate gastric tube reconstruction is safe and effective. EOF doesnt increase the frequency of anastomotic insufficiency and other complications.

SPECIALIZED FOOD PRODUCTS FOR THE NUTRITION OF ATHLETES BASED ON WHEY PROTEINS

It is known that a balanced diet and the intake of specialized foods that combine various types of proteins play a key role in expanding the adaptive potential of athletes and affect the effectiveness of the training process. In recent decades, various biomedical and technological strategies have been implemented in the development of specialized food products, including those for the nutrition of athletes. Proteins of milk and whey occupy an important place among the functional ingredients. Despite the fact that the average per capita consumption of protein in the structure of the diet in the Russian Federation over the past few years has been at a satisfactory level (in 2019 - 80.4 g/day, in 2020 - 81.4 g/day), for athletes with high body weight and extremely high energy consumption (4000 kcal/day and above), these values will be insufficient. In connection with this, special attention should be paid to various protein fractions in the development of SPP at a consumption level of at least 1,2 g/kg of the athlete's body weight daily to ensure plastic and other functions in the body, physical performance and endurance.

Bioimpedance Analysis of Human Body Composition: Medical Applications, Terminology.

This article discusses the terminology features of bioimpedance analysis of body composition and the most common mistakes in the use of terms. In the Russian-speaking medical environment, you can often find the use of a number of inaccurate terms related to bioimpedance analysis of the human body composition. At the same time, the terminology of bioimpedance analysis of human body composition in English-language publications has long been established. The article presents the Russian and English terms of bioimpedance analysis of the human body composition with corresponding abbreviations, as well as the hierarchy of the terms body composition components, body composition parameters, parameters of bioimpedance analysis of body composition and bioimpedance parameters. The most developed areas of application of bioimpedance analysis in medical practice are discussed: assessment of nutrition and dynamic observations of changes in body composition, assessment of the body mineral mass, assessment of the body hydration parameters, assessment of blood supply to tissues and organs, including in the monitoring mode, assessment of the asymmetry of paired organs and limbs, assessment of pre-start readiness, physical development and the level of fitness of the athlete's muscular system.

Professor Igor V. Prianikov (08.04.1959-12.03.2021)

On March 12, 2021 at the sixty-second year of life, a member of the editorial colleague of the journal "Clinical Nutrition and Metabolism", Professor, Doctor of Medical Sciences Igor Valentinovich Pryanikov suddenly passed away. Talented, intelligent, with an amazing sense of humor, Igor Valentinovich has always inspired his colleagues with his positive attitude, boiling energy and ability to work.

Screening methods for assessing the nutritional status of young children with intestinal infection

Assessment of the nutritional status in children with infectious pathology is an important and necessary event in the routine practice of a pediatrician. The article describes the basic principles of assessing the nutritional status of children with intestinal infections. The main laboratory markers are shown, changes in which may indicate the risk of developing nutritional insufficiency and a more severe course of the disease. In the conditions of an infectious hospital, screening methods for assessing the nutritional status can be used. There are different scales and tools for screening, further research is needed to identify the most optimal method.

Phase angle. Medical interpretations and applications.

The choice of the topic of this work is due to the interest of specialists using bioimpedance technology for assessing the rate of metabolic processes and body composition, to the possibilities of the clinical application of the phase angle. Phase angle (PhA) is a parameter specific only to the bioimpedance method of obtaining information about body composition. In the early 2000s, it was shown that low PhA values in catabolic diseases can be used to assess survival, while high values can be used to assess the fitness of the muscular system in athletes and other individuals who regularly exercise. Systematic reviews and meta-analyzes of subsequent years have summarized the evidence base of these provisions and identified a number of new applications - in sarcopenia, anorexia, and renal failure. In assessing nutrition, PhA is used to indirectly characterize both the protein fraction of the body and the rate of metabolic processes.

SARCOPENIA: HOW TO DIAGNOSE IT?

Annotation. An increase in life expectancy is associated with an increase in the number of people suffering from drug addiction. The development of sarcopenia significantly reduces the quality of life of patients and worsens the results of treatment in the event of life-threatening conditions. Unfortunately, clinicians do not always assess the condition of the muscles. Different scales are used to detect sarcopenia at the prehospital stage. In the hospital, the possibility of using scales is limited, and instrumental diagnostic methods are more informative. The most popular is ultrasound imaging of muscle tissue. The dynamics of the severity of sarcopenia is a promising method used to assess nutritional support and rehabilitation measures in resuscitation patients.

Venous access for parenteral nutrition: what has changed over the past 12 years?

The article provides an overview of the significant changes in clinical practice that have occurred since the publication of the European Association for Clinical Nutrition and Metabolism (ESPEN) guidelines on providing vascular access for parenteral nutrition (PN), regarding the choice of vascular access, prevention and treatment of the most common important complications of long-term venous access - catheter-associated bloodstream infection and obstruction of the internal lumen of the catheters. The preferred vascular access for PN for medium- to long-term PN - a tunneled central venous catheter (TCVC), PICC catheter, or a fully implantable port system (PIPS) - is now largely determined by the underlying disease, near-term prognosis and patient comfort, and with short-term PN in a hospital largely depends on the capabilities of a particular medical institution. Strict adherence to modern standard measures for infection control and care of venous access and infusion lines, hand hygiene, appropriate training of medical personnel, patients and their caregivers are currently the most reliable and effective method of preventing CAIC. Taurolidine catheter lock is used as an additional measure. In most cases, the occlusion of the inner canal of the catheter can be eliminated by the drug method, however, its effectiveness directly depends on the correspondence of the chosen drug to the cause of the occlusion. In general, the changes that have occurred in recent years have significantly reduced the incidence and risk of PN complications associated with vascular access.

The Effects of Oral Nutritional Support on the Ability of the COVID-19 Patients to Recover: A Prospective, Open, Multicenter, Comparative in Two Groups, Observational Study

Background. Nutritional insufficiency and decreased muscle mass of patients diagnosed with COVID-19 leads to prolonged respiratory support, stay in ICU and hospital, as well as reduced muscle strength and quality of life in the recovery period after a viral pneumonia caused by COVID-19. Aims: To study the effects of oral nutritional support on the physical health recovery of COVID-19 patients. Materials and methods. A prospective, open, multicenter, comparative observative study of two groups, observational study was initiated to evaluate the effects of oral nutritional support (ONS) by Nutridrink 200 ml on the ability of COVID-19 patients to recover. The patients with these criteria were included in the study: aged 1869; a confirmed COVID-19 infection; requires respiratory support; ability to consume more than 60% of food from the total required; presence of a signed consent form. One group received supplementary oral nutritional support (ONS) everyday for 28 days from the day of inclusion. The other group received standard diet. The primary endpoint was the evaluation of quality of life using the SF-36 questionnaire and the changes in the hand grip strength between the 3rd and 1st visits. Secondary endpoints of the study were length of stay in hospital and duration of respiratory support in the hospital. Results. 205 patients with a COVID-19 infection were included in the study. The final number of patients included in the study was 185 patients. Median age was 55 years old. The majority of patients were male 57.84% (107 patients). Upon evaluation of the physical component of quality of life using the SF-36 questionnaire, we obtained a statistically significant difference between the control and study groups on the 4th visit 44.285.45 and 46.586.76 respectively (p=0.012). Muscle strength was statistically different in the control (4.011.15 daN) and study (6.12.06 daN) groups (p 0.0001). The duration of respiratory support was significantly lower in the study group, 6.71.30 days as opposed to 8.141.52 days in the control group (p 0.0001). Also, in the group with oral nutritional support, there was a statistically significant decrease in the length of stay in hospital. In the control group, the average length of stay in hospital was 16.472.93 days, whereas in the study group it was 13.162.69 days (p 0.0001). Conclusion. Oral nutritional support given to oxygen dependent COVID-19 patients improves rehabilitation potential including preservation of muscle mass and function, reducing oxygen support requirements and length of stay in hospital.