The use of indicators of the regeneration of decubital ulcers in a comprehensive assessment of the nutritional status of patients in a chronic critical illness
- Authors: Yakovleva A.V.1, Altuhov E.L.1, Gorshkov K.M.1, Yakovlev A.A.1, Osmanov J.G.2, Shestopalov A.E.3,2, Shulutko A.M.2, Shchelkunova I.G.1, Gandybina E.G.2
-
Affiliations:
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology
- Sechenov University
- Russian Medical Academy of Continuing Professional Education
- Issue: Vol 23, No 1 (2020)
- Pages: 63-68
- Section: Articles
- URL: https://rjmseer.com/1560-9537/article/view/34280
- DOI: https://doi.org/10.17816/MSER34280
- ID: 34280
Cite item
Abstract
Background: Thanks to advances in emergency medical and surgical care, the number of patients experiencing acute critical illnesses is increasing. However, a group of patients in the so-called chronic critical illness (CCI) was formed. In this category of patients, the problem of treating decubital ulcers is relevant, since they are characterized by a combination of prolonged immobilization, severe protein catabolism, neuroendocrine and metabolic disorders, protein-energy malnutrition (PEN) and tissue trophic disorders.
Aims: Analyze the correlation of the degree of regeneration of decubital ulcers according to the Bates-Jenson scale in the modification S.Y.R. in relation to indicators of the nutritional status of patients in the CCI after brain damage.
Materials and methods: The study included 26 patients with pressure ulcers II, III, IV stage with PEN. To evaluate decubital ulcers, the adapted Bates-Jensen scale in the S.Y.R. modification was used. (with graphic model). The severity of PEN was evaluated by a complex of anthropometric (BMI, shoulder circumference, thickness of the skin-fat fold, circumference of the shoulder muscles) and laboratory (transferrin, absolute lymphocyte count) indicators. The dynamics of anthropometric indicators and the results of laboratory studies were separately considered.
Results: As a result, it was found that the change in anthropometric data correlated with laboratory parameters and the healing rate of decubital ulcers in only 26.9% of cases. Moreover, this correlation between the dynamics of transferrin and the absolute number of lymphocytes with the regeneration of decubital ulcers was observed in all patients. The obtained results demonstrated a direct correlation between the dynamics of healing of pressure ulcers and changes in laboratory indicators of nutritional status (as opposed to anthropometry data) in patients who are in a CCI after brain damage.
Conclusions: These findings provide an opportunity to review the weight of indicators in assessing the severity of protein-energy malnutrition, as well as introducing the rate of regeneration of a decubital ulcer in the presence of a patient into the assessment of the nutritional status.
Full Text
About the authors
Alexandra V. Yakovleva
Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology
Author for correspondence.
Email: avyakovleva@fnkcrr.ru
ORCID iD: 0000-0001-9903-7257
SPIN-code: 3133-3281
младший научный сотрудник лаборатории нутригеномики и нутригенетики НИИ реабилитологии
Russian Federation, MoscowEvgenij L. Altuhov
Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology
Email: ealtuhov@fnkcrr.ru
Russian Federation, Moscow
Kirill M. Gorshkov
Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology
Email: kmgorshkov@fnkcrr.ru
ORCID iD: 0000-0002-5443-2330
SPIN-code: 5991-9705
Russian Federation, Moscow
Alexey A. Yakovlev
Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology
Email: ayakovlev@fnkcrr.ru
ORCID iD: 0000-0002-8482-1249
SPIN-code: 2783-9692
заместитель руководителя НИИ реабилитологии
Russian Federation, MoscowJel'han G. Osmanov
Sechenov University
Email: mma-os@yandex.ru
Russian Federation, Moscow
Alexandr E. Shestopalov
Russian Medical Academy of Continuing Professional Education; Sechenov University
Email: ashest@yandex.ru
ORCID iD: 0000-0002-5278-7058
SPIN-code: 7531-6925
Russian Federation, Moscow
Alexandr M. Shulutko
Sechenov University
Email: shulutko@mail.ru
Russian Federation, Moscow
Inessa G. Shchelkunova
Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology
Email: ishchelkunova@fnkcrr.ru
ORCID iD: 0000-0002-3778-5417
SPIN-code: 8319-4170
Russian Federation, Moscow
Elena G. Gandybina
Sechenov University
Email: gandybina.e@gmail.com
ORCID iD: 0000-0002-6765-5154
Russian Federation, Moscow
References
- Maclntyre NR, Epstein SK, Carson S, et al. Management of patients requiring prolonged mechanical ventilation: report of a NAMDRC consensus conference. Chest. 2005;128(6):3937−3954. https://doi.org/10.1378/chest.128.6.3937.
- Petrova M.V. Nutritivno-metabolicheskaya terapiya u patsiyentov v khronicheskom kriticheskom sostoyanii posle tserebral’noy katastrofy: posobiye dlya vrachey. Moscow: Grin Print; 2018. 39 р. (In Russ).
- 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. https://doi.org/10.1016/j.clnu.2018.08.037.
- Leyderman I.N., Gritsan A.I., Zabolotskikh I.B., et al. Perioperatsionnaya nutritivnaya podderzhka. Klinicheskiye rekomendatsii. Vestnik intensivnoy terapii imeni A.I. Saltanova. 2018;(3):5–21. (In Russ).
- Cederholm T, Barazzoni R, Austin P, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr. 2017;36(1):49−64. https://doi.org/10.1016/j.clnu.2016.09.004.
- Parenteral’noye i enteral’noye pitaniye: natsional’noye rukovodstvo. Ed by M.Sh. Khubutiya, A.I. Saltanov. Moscow: GEOTAR-Media; 2015. 799 p. (In Russ).
- Iakovlev AA, Shaibak AA, Rebrov KS, et al. Kompleksnoye lecheniye dekubital’nykh yazv kak osnovnaya sostavlyayushchaya programmy ranney reabilitatsii u patsiyentov s povrezhdeniyami golovnogo mozga. Siberian Journal of Life Sciences and Agriculture. 2017;9(4). https://doi.org/10.12731/wsd-2017-4-240-256.
- McInnes E, Jammali-Blasi A, Bell-Syer SE, et al. Support surfaces for pressure ulcer prevention. Cochrane Database Syst Rev. 2015;(9):CD001735. https://doi.org/10.1002/14651858.CD001735.pub5.
- Lyder C. Exploring pressure ulcer prevention and management. JAMA. 2003;289:223−226. https://doi.org/10.1001/jama.289.2.223.
- Stratton RJ, Ek AC, Engfer M, et al. Enteral nutritional support in prevention and treatment of pressure ulcers: a systematic review and meta-analysis. Ageing Res Rev. 2005;4(3):422−450. https://doi.org/10.1016/j.arr.2005.03.005.
- Cereda E, Gini A, Pedrolli C, Vanotti A. Disease-specific, versus standard, nutritional support for the treatment of pressure ulcers in institutionalized older adults: a randomized controlled trial. J Am Geriatr Soc. 2009;57(8):1395−402. https://doi.org/10.1111/j.1532-5415.2009.02351.x.
- Cereda E, Neyens JC, Caccialanza R, et al. Efficacy of a disease-specific nutritional support for pressure ulcer healing: a systematic review and meta-analysis. J Nutr Health Aging. 2017;21(6): 655–661. https://doi.org/10.1007/s12603-016-0822-y.