Background: Malnutrition is a critical concern in ICU settings. It is associated with increased morbidity and mortality, yet its prevalence and impact on clinical outcomes in patients with stroke and traumatic brain injury (TBI) remain underexplored. Objective: To evaluate the prevalence and impact of malnutrition risk on clinical outcomes in ICU patients with TBI, ischemic stroke, and hemorrhagic stroke, and to identify key risk factors associated with malnutrition risk. Methods: This retrospective cohort study utilized electronic health records encompassing ICU admissions from 2017 to 2023. Patients with either stroke or TBI were included, with malnutrition risk assessed using the prognostic nutritional index. Data were extracted and analyzed to determine patient characteristics, clinical and laboratory parameters, and outcomes. Results: This study included 1352 patients (267 TBI, 825 ischemic stroke, and 260 hemorrhagic stroke patients, >30% with pneumonia at admission). Severe malnutrition risk at admission was observed in over 60% of patients. Stroke patients, particularly those with hemorrhagic stroke, exhibited a higher risk of malnutrition compared to TBI patients. Malnutrition risk was associated with significantly higher hospital mortality and increased need for mechanical ventilation. Predictive factors for malnutrition risk included advanced age, higher SOFA scores, lower FOUR and GCS scores, and the presence of pneumonia at admission. Conclusions: Risk of malnutrition is highly prevalent among ICU patients with TBI, ischemic, and hemorrhagic stroke, significantly impacting mortality and other clinical outcomes. Identifying and managing malnutrition early in the ICU setting is crucial for improving patient outcomes. Further prospective, multicenter studies are needed to validate these findings and develop effective interventions.

Background: Brain injuries, including stroke and traumatic brain injury (TBI), pose a major healthcare challenge due to their severe consequences and complex recovery. While ischemic strokes are more common, hemorrhagic strokes have a worse prognosis. TBI often affects young adults and leads to long-term disability. A critical concern in these patients is the frequent development of chronic critical illness, compounded by metabolic disturbances and malnutrition that hinder recovery. Objective: This study aimed to compare changes in nutritional status parameters under standard enteral nutrition protocols and clinical outcomes in prolonged/chronic critically ill patients with TBI or stroke versus such a population of patients without TBI or stroke. Methods: This matched prospective–retrospective cohort study included intensive care unit (ICU) patients with TBI or stroke from the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology and patients without these conditions from the eICU-CRD database. Inclusion criteria comprised age 18–74 years, ICU stay >5 days, and enteral nutrition. Patients with re-hospitalization, diabetes, acute organ failure, or incomplete data were excluded. Laboratory values and clinical outcomes were compared between the two groups. Propensity score matching (PSM) was used to balance baseline characteristics (age, sex, and body mass index). Results: After PSM, 29 patients with TBI or stroke and 121 without were included. Univariate analysis showed significant differences in 21 laboratory parameters and three hospitalization outcomes. On day 1, the TBI/stroke group had higher hemoglobin, hematocrit, lymphocytes, total protein, and albumin, but lower blood urea nitrogen (BUN), creatinine, and glucose. By day 20, they had statistically significantly lower calcium, BUN, creatinine, and glucose. This group also showed less change in lymphocytes, calcium, and direct bilirubin. Hospitalization outcomes showed longer mechanical ventilation duration (p = 0.030) and fewer cases of acute kidney injury (p = 0.0220) in the TBI/stroke group. Conclusions: TBI and stroke patients exhibit unique metabolic patterns during prolonged/chronic critical illness, differing significantly from other ICU populations in protein/glucose metabolism and complication rates. These findings underscore the necessity for specialized nutritional strategies in neurocritical care and warrant further investigation into targeted metabolic interventions.

BACKGROUND: The resolution of intestinal insufficiency syndrome remains one of the urgent problems of nutritional support for patients with traumatic brain injury (TBI) and chronic critical illness. AIM: To determine the effectiveness of intestinal lavage in restoring the basic functions of the gastrointestinal tract and microbiocenosis in patients with chronic critical illness. MATERIALS AND METHODS: This prospective, randomized, single-center study analyzed 56 men with TBI of various etiologies and chronic critical illness. At the beginning of treatment and on day 10, the effectiveness of gastrointestinal lavage was evaluated as a complex intensive treatment of intestinal insufficiency syndrome. RESULTS: Patients were randomized into two groups depending on the conduct of intestinal lavage. In group 1 (n=27), enteral tube feeding was performed according to the standard method. In group 2 (n=29), intestinal lavage was also performed and an enterosorbent was added to the saline enterosorbent solution, three procedures with an interval of 3 days. A significant positive dynamics of carbohydrate and protein metabolism, restoration by day 10 of the barrier function of the intestine, motility of the gastrointestinal tract, and microbiocenosis were observed in group 2 (main group) compared with those in group 1 (control). CONCLUSION: The inclusion of gastrointestinal lavage in the complex intensive therapy for SCI in patients with a chronic critical illness for a short period helps resolve the main pathogenetic links of SCI restoration of the barrier function of the intestine, digestive transport, motor evacuation processes in the gastrointestinal tract, normalization of microbiocenosis, and metabolic parameters and nutritional status.

Саркопения у пациентов после тяжелых повреждений головного мозга

Due to modern advances in medicine, more and more patients survive after severe acute diseases. However, some such patients remain dependent on life-support systems. Therefore, a chronic critical condition is an urgent problem for patients in the intensive care unit. The main syndrome of this complex is maladaptive responses to long-term existing stress factors. This review examines the main pathophysiological mechanisms of chronic critical illness, as well as the resulting metabolic disorders. A literature search was conducted in the English-language databases of medical and biological publications PubMed and Scopus, as well as the Russian bibliographic system RSCI. The coverage interval was the last 20 years. Emphasis was placed on the systemic inflammatory reaction; the reaction of hypermetabolism-hypercatabolism; disorders of carbohydrate, protein, and fat metabolism; and the development of secondary sarcopenia. In conclusion, the volume of metabolic control and intensive nutritional and metabolic support, which are critical components of a comprehensive approach to the treatment of chronic critical illness, are key considerations considered.

Management of deep pressure ulcers remains an actual problem in modern purulent surgery because there is neither decrease in the number of patients nor in the relapse percentage.Objective: optimization of the treatment protocol for pressure ulcer management in patients with chronic critical state of cerebral origin.Material and methods. 63 patients, aged 21–74, in chronic critical state and with decubital ulcers of varying depth and location were treated using high-frequency electrical stimulation. Lesion depth was equal to degree II–III by the classification of Agency for Health Care Policy and Research (1992). The stimulation technique and its technological support are described in details. Objective control included bacteriological and morphological tests and Bates-Jensen scale.Research results. The data obtained from the studied group of patients (demographic and clinical parameters) were compared to the similar data of 34 patients from the comparison group who had standard therapy. High-frequency electrical stimulation promoted qualitative acceleration of reparative processes in chronic wounds, thus reducing the overall time of treatment and rehabilitation.Conclusion. High-frequency electrical stimulation can be recommended as an additional physical action at chronic wound processes in patients in chronic critical condition.