Optimal metabolic targets for provision of protein and energy in severe trauma patients in ICU

One of the most important components of the clinical pattern of severe trauma is hypermetabolism-hypercatabolism syndrome. Nutritional support plays significant role in improving clinical outcomes of ICU patients. The goal of this trial was to determine the optimal metabolic targets for protein and energy provision for severe trauma ICU patients, improving the indicators of clinical outcome and reducing the infectious complications rate. Materials and methods. 86 ICU patients with severe trauma of chest and abdomen were included. Priority in nutritional suppori was previously enteral nutrition. The critical level of protein and energy provision on the 3rd day of treatment in the ICU was determined by incrementally increasing protein delivery by 0.1 g/kg per day, starting from 0.5 g/kg per day and energy delivery to 1 kcal/kg per day, starting from 20 kcal/kg per day and forming 2 comparison groups, respectively. Results. The statistically significant level of protein provision was 1.3 g/kg per day and more for protein and 31 kcal/kg per day and more for energy targets. The average length of stay (LOS) in the hospital of the group «Protein > 1.3 g/kg per day)> (n = 64) was 1.6 day less than in the group «Protein < 1.3 g/kg per day)> (n = 22), p = 0.03; the group «Energy > 31 kcal/kg per day» (n = 62) demonstrated significantly lower LOS in the hospital (1.8 day) than the group «Energy < 31 kcal/kg per day (n = 24), p = 0.011. Nosocomial infectious complications were found out in 8 (13 %) patients in the group «Protein > 1.3 g/kg per day)>, in the group «Protein < 1.3 g/kg per day)> in 8 (36 %) patients (Y2 = 4.68; p = 0.031). In the group «Energy > 31 kcal/kg per day» infectious complications rate was 11 %, and in the group «Energy < 31 kcal/kg per day»-38 % (Y2 = 6.21; p = 0.013). Summary. Protein provision at least 1.3 g/kg per day and energy of at least 31 kcal/kg per day on the 3rd day of ICU treatment led to significant reduction of nosocomial infectious complications rate and LOS in the hospital.

optimal metabolic targets for the delivery of protein and energy, nutritional support, severe trauma of chest and abdomen, nosocomial infectious complications

1. Королев В. М. Эпидемиологические аспекты сочетанной травмы. Дальневосточный медицинский журнал. 2011; (3): 124-8.

2. Галятина Е. А., Агаларян А. Х., Шерман С. В. Анализ результатов хирургического лечения абдоминальных повреждений при политравме у детей. Политравма. 2013; (3): 43-50.

3. Мешаков Д. П. Особенности интенсивной терапии у пострадавших с тяжелой сочетанной травмой головы и груди. Вестник анестезиологии и реаниматологии. 2012; 9: (2): 22-6.

4. Самохвалов И. М., Щеголев А. В., Гаврилин С. В., Недомолкин С. В., Мешаков Д. П. Анестезиологическая и реаниматологическая помощь пострадавшим с политравмой. СПб.: ИнформМед, 2013.

5. Энтеральное и парентеральное питание: национальное руководство. Под ред. А.И Салтанова, Т. С. Поповой. М.: ГЭОТАР-Медиа, 2014.

6. Лейдерман И. Н., Николенко А. В., Сивков О. Г. Нутритивная поддержка в отделении реанимации и интенсивной терапии. Стандартные алгоритмы и протоколы: Учебно-методическое пособие для врачей, клинических ординаторов, врачей интернов. М., 2010.

7. Клиническое питание больных в интенсивной медицине: практическое руководство. Под ред. В. М. Луфта, С. Ф. Багненко. СПб.: «Арт-Экспресс», 2013.

8. Шестопалов А. Е., Пасько В. Г., Стец В. В. Нутритивная поддержка у пострадавших с тяжёлой сочетанной травмой. Медицинский алфавит. Неотложная медицина. 2011; (4): 35-40.

9. Allingstrup M.J., Esmailzadeh N., Wilkens Knudsen A., Espersen K., Hartvig Jensen T., Wiis J. et al. Provision of protein and energy in relation to measured requirements in intensive care patients. Clin Nutr. 2012; (31): 462-8.

10. Heidegger C. P., Berger M. M., Graf S., Zingg W., Darmon P., Costanza M. C. et al. Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial. The Lancet. 2013; 381: (9864): 385-93.

11. Singer P., Anber R., Cohen J., Shapiro H., Shalita-Chesner M., Lev S. et al. The Tight Calorie Control Study (TICACOS): a prospective, randomized, controlled pilot study of nutritional support incritically ill patients. Int Care Med. 2011; (37): 601-9.

12. Weije P., Stapel S. N., Groot S., Driessen R. H., de Jong E., Girbes A. R. et al. Optimal protein and energy nutrition decreases mortality in mechanically ventilated, critically ill patients: a prospective observational cohort study. Journal of Parenteral and Enteral Nutrition. 2012; 36: (1): 60-8.