Medical and Social Expert Evaluation and RehabilitationMedical and Social Expert Evaluation and Rehabilitation1560-95372412-2092Eco-Vector3428010.17816/MSER34280Research ArticleThe use of indicators of the regeneration of decubital ulcers in a comprehensive assessment of the nutritional status of patients in a chronic critical illnessYakovlevaAlexandra V.avyakovleva@fnkcrr.ruhttps://orcid.org/0000-0001-9903-7257AltuhovEvgenij L.ealtuhov@fnkcrr.ruGorshkovKirill M.kmgorshkov@fnkcrr.ruhttps://orcid.org/0000-0002-5443-2330YakovlevAlexey A.ayakovlev@fnkcrr.ruhttps://orcid.org/0000-0002-8482-1249OsmanovJel'han G.mma-os@yandex.ruShestopalovAlexandr E.ashest@yandex.ruhttps://orcid.org/0000-0002-5278-7058ShulutkoAlexandr M.shulutko@mail.ruShchelkunovaInessa G.ishchelkunova@fnkcrr.ruhttps://orcid.org/0000-0002-3778-5417GandybinaElena G.gandybina.e@gmail.comhttps://orcid.org/0000-0002-6765-5154Federal Research and Clinical Center of Intensive Care Medicine and RehabilitologySechenov UniversityRussian Medical Academy of Continuing Professional Education1508202023163680106202008062020Copyright © 2020, Eco-Vector2020<p><strong>Background: </strong>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.</p>
<p><strong>Aims:</strong> 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.</p>
<p><strong>Materials and methods:</strong> 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.</p>
<p><strong>Results:</strong> 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.</p>
<p><strong>Conclusions: </strong>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.</p>pressure ulcerprotein-energy malnutritionBates-Jensen scalechronic critical illnessдекубитальная язвапролеженьбелково-энергетическая недостаточностьшкала Бейтс-Дженсенхроническое критическое состояние[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.]