Malnutrition among surgical patients is rather common problem. The degree and severity of malnutrition after surgery significantly correlates with the length of stay in the intensive care unit and surgical hospital, rate of infectious complications development, unsatisfactory results of treatment and increased costs. The presented clinical recommendations clarifies key methods for the prevention of development, diagnosis and treatment of the protein-energy malnutrition (PEM) syndrome in the pre and postoperative period. The choice of methods for diagnosis and PEM correction during the perioperative period is based on studies evaluated from the endpoints of evidence-based medicine. In applications, key quality criteria for treatment, as well as algorithms of actions in the preoperative and postoperative period are presented.

Numerous publications show that, depending on the type of pathology, protein-energy malnutrition develops in 20– 50 % of surgical patients directly in the hospital in the early postoperative period. Rather a great number of patients with surgical diseases are already hospitalized with varying degrees of malnutrition. From 30 % to 69 % of patients are admitted to the hospital with I–III grade of protein-energy malnutrition and require mandatory nutritional support. Risk factors for protein-energy malnutrition development are determined in 60–70 % of hospitalized patients. This clinical practice recommendations present the basic principles of nutritional support in the perioperative period.

Все пациенты отделений реанимации и интенсивной терапии (ОРИТ), которым проводят искусственную вентиляцию легких (ИВЛ), нуждаются в нутритивной поддержке, осуществляемой энтерально и парентерально. Важными особенностями пациентов, находящихся на длительной ИВЛ, являются неспособность в течение длительного времени питаться через рот, затяжное течение синдрома гиперкатаболизма—гиперметаболизма вследствие полиорганной дисфункции, высокая частота развития инфекционных осложнений, длительное применение антибактериальной терапии, а также опиоидов, бензодиазепинов, агонистов альфа-2 адренорецепторов, мышечных релаксантов, существенно влияющих на показатели кислородного и энергетического обмена. В данных методических рекомендациях представлены основные принципы проведения метаболического мониторинга и нутритивной поддержки у пациентов ОРИТ, находящихся на длительной ИВЛ.

The article provides the main statements of the guidelines for the anesthesia and intensive care of patients with the coronavirus disease (COVID-19), developed by the Federation of Anesthesiologists and Reanimatologists of Russia. In the process of developing the recommendations, the publications of the official websites of the Russian Federation, the electronic databases of the RSCI, PubMed, MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were analyzed by the developers independently of each other. The date of the last search query was June 29, 2020. To develop the Guidelines for the recommendations, were used documents that directly describing the features of the management of patients with coronavirus disease COVID-19 (guidelines and guidelines — 16; randomized clinical trials and Cochrane Reviews — 8; observational and comparative studies — 77; other documents, notes and comments — 54) and describing anesthetic and resuscitation support in the general population of patients. The provisions of the recommendations highlight the specifics of anesthesia, intensive care, resuscitation, manipulation, and prevention of the spread of COVID-19 in the implementation of these activities. Methods of protecting personnel from infection with COVID-19 during manipulations, anesthesia and intensive care are considered. The features of respiratory support, extracorporeal detoxification, extracorporeal membrane oxygenation, thromboprophylaxis are described. The features of the management of pregnant women, children of different age, patients with concomitant diseases, issues of transportation of patients are considered.

Perioperative respiratory complications are one of the main problems in anesthesiology and intensive care, in some areas of surgery they occupy the first place in the structure of all complications of the perioperative period. Initial respiratory failure, as well as the presence of disorders of respiratory functions increase the risk of its development, often leading to an unfavorable outcome of the disease. The recommendations on perioperative management of patients with respiratory failure include modern standards of preoperative assessment of risk factors for respiratory insufficiency, prevention and treatment of perioperative respiratory disorders in Russian Federation. The recommendations describe the principles of diagnosis of respiratory failure, the choice of anesthesia in concomitant lung diseases, the basics of protective ventilation and prevention of postoperative pulmonary complications.