02 October 2012

Feed the sick!

There is to live
Clinical nutrition is also a necessary element of treatment,
like medications and surgery, doctors sayYulia Smirnova, "Science and Life"

It often happens like this – the doctor performed a brilliant operation, the patient was literally pulled out of the other world, but after a while it turns out that not for long.

In many cases, this is due to the fact that a person does not receive proper postoperative care, the most important element of which is clinical nutrition. Doctors who put it into practice recognize that it is no less important component of recovery than antibiotics or physiotherapy.

The teleconference "Clinical nutrition: "The lost element of Hi-tech therapy?" held at the RIA Novosti news agency was dedicated to the introduction of clinical nutrition in our country. between Moscow and St. Petersburg, which was attended by doctors and experts in clinical nutrition.

We are not talking about what patients receive in hospital canteens, but about specialized mixtures for parenteral administration (intravenously through a central catheter) and enteral (through a probe).

This is necessary for those who cannot, do not want or should not eat in the usual way – after operations, with severe burns, comatose state, some neurological and mental diseases and other pathological conditions.

When a person finds himself in a serious condition, his energy need increases dramatically. 25-30 non-protein kcal per kilogram of weight per day is taken as the base value in the calculations of energy needs.

At rest on a bed, the patient needs about 30-36 kcal per kg of weight, after radical operations for cancer – 50-60 kcal / kg, with severe mechanical skeletal injuries – 50-70 kcal / kg, with traumatic brain injuries - 60-80 kcal / kg. In severe cases, the energy requirement exceeds 3000 kcal per day, which is about the same amount as intensively trained athletes or nursing mothers spend, and if you add to this that a person may be unconscious or with a complete lack of appetite, then it is quite problematic to provide him with the necessary energy.

In addition, this method of nutrition allows you to strictly control not only the quantity, but also the quality of food. Relatives visiting patients are ready to feed patients with anything from the kindest motives, but in the end such care can serve a bad service – the energy that the body should spend on recovery is spent on digesting delicacies.

According to statistics, the spread of "hospital starvation" – the lack of necessary nutrients by hospital patients – is up to 75% of the total. This means that the vast majority of people who are sometimes in the most severe conditions, and who need an increased amount of energy to recuperate and fight the disease, experience a protein-energy deficit. In practice, it comes to the point that patients lose up to 1 kg of weight per day while in intensive care. And with a decrease in body weight in an inpatient patient by only 5%, the duration of hospitalization increases by 2 times, and the frequency of complications increases by 3.3 times.

The benefits of clinical nutrition, where it is used, were appreciated not only by doctors and patients, but also by economists. According to Andrey Yuryevich Kulikov, deputy editor-in-chief of the journals "Pharmacoeconomics. Modern pharmacoeconomics and pharmacoepidemiology" and "Modern organization of drug provision" when using clinical nutrition in intensive care units, it is possible to save up to 26 thousand rubles per patient. According to statistics, which experts rely on, the use of clinical nutrition reduces mortality in intensive care units by one and a half times, hospital stays are reduced by 2-3 days, and children who received nutritional support in the early stages of hospitalization are transferred from intensive care to bed units on average a week earlier after operations.

Surprisingly, like a number of other things, the introduction of clinical nutrition in modern Russia is a well–forgotten old one. Back in 1986, domestic mixtures for enteral nutrition were created and the necessary technical support for their use was developed. Moreover, these developments were even awarded a State Prize. Now the industry has to be rediscovered.

In pediatrics, as Professor Andrey Ustinovich Lekmanov said, things are better with clinical nutrition. This is largely because pediatricians initially pay more attention to the nutrition of children, and the introduction of new progressive practices in this area is better and easier. But, as in adult medicine, all specialists note insufficient education not only of doctors, but also of average medical staff. Neither pediatricians nor other doctors are taught in medical institutes what to do with a patient after the operation is over. Postgraduate education, advanced training courses and special educational programs save here, where doctors are explained under what conditions and what kind of nutrition should be prescribed to patients.

Returning to the figures, which, in theory, should stimulate the introduction of clinical nutrition into medical practice as a mandatory element of treatment, I would like to note that the emerging market in Russia is estimated at several tens of millions of euros. According to doctors, in those medical institutions where this practice is already used, clinical nutrition costs nothing to patients, since these drugs belong to medicines, and are prescribed by a doctor in cases where it is necessary.

But, of course, not all patients of intensive care units have the opportunity to receive a much-needed element of treatment. And not only in intensive care, clinical nutrition can be useful. Even after the removal of appendicitis or other simple surgical procedures, the patient cannot eat for some time. But this is the time when the body desperately needs energy to restore strength, especially if the patient had protein-energy balance disorders even before the operation. Clinical nutrition could also be useful here. According to the research of the Research Institute of Nutrition of the Russian Academy of Medical Sciences, patients admitted to hospitals have major nutritional status disorders – up to 20% suffer from exhaustion, half with impaired fat metabolism and up to 90% have signs of hypo- and vitamin deficiency. "It is necessary to assess the nutritional status of the patient even before the operation, and then observe the dynamics," said Professor Alfred Arkadyevich Zvyagin, chief researcher at the Vishnevsky Institute of Surgery.

It's not just in our country that things are so bad. According to Professor Allesandro Laviano, Chairman of the Committee on Education and Clinical Practice of the European Society for Clinical Nutrition and Metabolism (ESPEN), only 60% of the necessary clinical nutrition is provided in Europe.

And abroad, and now in our country, the so-called "Nutrition day" is held, days when many medical institutions keep records of a variety of parameters in the practice of clinical nutrition. Based on the data obtained, reports are compiled, the purpose of which, among other things, is to demonstrate benefits for the patient, for the clinic, and for the health care system. And for the state economy as a whole, since patients who received clinical nutrition regain their ability to work faster. In Russia, such a day was held for the first time in November last year. 101 intensive care units and about 1000 patients took part in the action.

Portal "Eternal youth" http://vechnayamolodost.ru02.10.2012

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