Nutritional status and nutritional support of patients with chronic disorders of consciousness at the stage of medical rehabilitation

• Mikhail V. Nikiforov
• Sergei S. Aleksanin
• Andrey A Korolev

Abstract

Chronic disturbances of consciousness (CDC) are a consequence of severe brain damage and are conditions that arise after emerging from a coma with the preservation of the sleep-wake cycle in the absence of signs of conscious behavior. When conducting inpatient medical rehabilitation of this group of patients, the state of nutritional status is not always taken into account and, as a rule, there is no nutritional support with an assessment of metabolic needs, including the introduction of various modes of physical activity during physical therapy and an increase in physical load on the patient’s body.

The purpose of the study was to assess the nutritional status and optimize the nutritional support system in patients with CDC at the inpatient stage of medical rehabilitation (MR).

Material and methods. The study analyzed the results of examination and treatment of 152 patients with CDC of traumatic origin who received medical rehabilitation from 2016 to 2022 in the Department of Physical and Rehabilitation Medicine of the Nikiforov Russian Center of Emergency and Radiation Medicine, Ministry of Russian Federation for Civil Defense, Emergencies and Elimination of Consequences of Natural Disasters.

Results. In patients with CDC of traumatic genesis, signs of malnutrition (objective, anthropometric, laboratory) were diagnosed at the inpatient stage of MR, and there were also risks of malnutrition progression with the introduction of additional physical activity.

Conclusion. To create an effective and adequate nutritional support system during inpatient MR, metabolic monitoring (indirect calorimetry) is of fundamental importance, taking into account the influence of additional physical activity. The use of a calculation method for estimating energy requirements can lead to hyperalimentation.

Keywords:nutritional status; nutritional support; indirect calorimetry; chronic impairment of consciousness; energy expenditure

References

1. Belkin A.A., Aleksandrova E.V., Akhutina T.V. Belkin V.A., Berdnikovich E.S., Bykova V.I., et al. Chronic Disorders of Consciousness: guidelines of the All-Russian public organization «Federation of Anesthesiologists and Reanimatologists». Vestnik intensivnoy terapii imeni A.I. Saltanova [Bulletin of Intensive Care named after A.I. Saltanov]. 2023; (3): 7–42. DOI: https://doi.org/10.21320/1818-474X-2023-3-7-42 (in Russian)

2. Giacino J.T., Katz D.I., Schiff N.D., Whyte J., Ashman E.J., Ashwal S., et al. Practice guideline update recommendations summary: disorders of consciousness. Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology; the American Congress of Rehabilitation Medicine; and the National Institute on Disability, Independent Living, and Rehabilitation Research. Neurology. 2018; 91 (10): 450–60. DOI: https://doi.org/10.1212/WNL.0000000000005926 PMID: 30089618; PMCID: PMC6139814.

3. Kondziella D., Stevens R.D. Classifying disorders of consciousness: past, present, and future. Semin Neurol. 2022; 42 (3): 239–48. DOI: https://doi.org/10.1055/a-1883-1021

4. Ivanova G.E., Bulatova M.A., Polyaev B.B., Trofimova A.K. Application of the International classification of functioning, disabilities and health in the rehabilitation process. Vestnik vosstanovitel’noy meditsiny [Bulletin of Restorative Medicine]. 2021; 20 (6): 4–33. DOI: https://doi.org/10.38025/2078-1962-2021-20-6-4-33 (in Russian)

5. Belkin A.A., Alasheev A.M., Belkin V.A., Belkina Yu.B., Belova A.N., Belsky D.V., et al. Rehabilitation in the intensive care unit (RehabICU). Clinical practice recommendations of the national Union of Physical and Rehabilitation Medicine Specialists of Russia and of the national Federation of Anesthesiologists and Reanimatologists. Russian Federation of anesthesiologists and reanimatologists guidelines. Vestnik intensivnoy terapii imeni A.I. Saltanova [Bulletin of Intensive Care named after A.I. Saltanov]. 2022; (2): 7–40. DOI: https://doi.org/10.21320/1818-474X-2022-2-7-40 (in Russian)

6. Luft V.M., Afonchikov V.S, Dmitriev A.V., et al. Clinical Nutrition Guide. Monograph. Saint Petersburg: Art-Ekspress, 2016: 492 p. (in Russian)

7. Nikiforov M.V., Korolev A.A. Evaluation of the effectiveness and technology of nutritional support of victims in emergency situations with a long-term impairment of consciousness due to traumatic brain injury. Mediko-biologicheskie i sotsial’no-psikhologicheskie problemy bezopasvosti v chrezvychaynykh situatsiyakh [Medico-Biological and Socio-Psychological Problems of Safety in Emergency Situations]. 2021; (4): 28–39. DOI: https://doi.org/10.25016/2541-7487-2021-0-4-28-39 (in Russian)

8. Leyderman I.N., Belkin A.A., Rakhimov R.T., Belkin V.A., Zhiguzhevsky R.A. The influence of verticalization on the dynamics of the energy demand at rest in patients with unresponsive wakefulness syndrome. Neotlozhnaya meditsinskaya pomoshch’. Zhurnal imeni N.V. Sklifosovskogo [Emergency Health Care. The journal named after N.V. Sklifosovsky]. 2020; 9 (3): 356–62. DOI: https://doi.org/10.23934/2223-9022-2020-9-3-356-362 (in Russian)

9. Ippoliti C., Fadeur M., Malherbe C., De Flines J., Verbrugge A.M., Gosseries O., et al. What is the nutritional status of patients with prolonged disorders of consciousness? A retrospective cross-sectional study. Brain Inj. 2023; 37 (1): 54–62. DOI: https://doi.org/10.1080/02699052.2022.2145361

10. Laureys S., Schiff N.D. Coma and consciousness: paradigms (re)framed by neuroimaging. Neuroimage. 2012; 61 (2): 478–91. DOI: https://doi.org/10.1016/j.neuroimage.2011.12.041

11. Colantonio A., Gerber G., Bayley M., Deber R., Yin J., Kim H. Differential profiles for patients with traumatic and nontraumatic brain injury. J Rehabil Med. 2011; 43 (4): 311–5. DOI: https://doi.org/10.2340/16501977-0783

12. Nikiforov M.V., Korolev A.A., Leyderman I.N. Metabolic monitoring in victims in emergency situations with prolonged impairment of consciousness. Meditsina katastrof [Disaster Medicine]. 2023; (1): 36–41. DOI: https://doi.org/10.33266/2070-1004-2023-1-36-41 (in Russian)

13. Nikiforov M.V., Korolev A.A. Peculiarities of trophological status in victims of emergencies with long consciousness impairment due to craniocerebral injury. Meditsina katastrof [Disaster Medicine]. 2021; (2): 50–4. DOI: https://doi.org/10.33266/2070-1004-2021-2-50-54 (in Russian)

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)