Nutritive support of patients is one of the most important components of treatment of the patient. The sufficient resources arriving with food are necessary for it for normal mobilization of an organism on fight against an infection. Especially it concerns a koronavirusny infection which in some cases differs in a long current and is fraught with development of complications.
When finding the patient in somatic office he, as a rule, receives one of standard tables and eats food independently. However absolutely other situation arises when the patient gets on treatment to intensive care unit and resuscitation, especially, if to it artificial ventilation of the lungs is carried out.
If we mean providing the patient with nutrients who is especially in a critical state, then this complex carries a concept of nutritive therapy. Nutritive therapy is a providing an enteroalimentation by means of ustroistvo of enteral access (probes, ostomies) or peroral putem (independent ̆ intake of special nutritious mixes ̆ — a siping) and parenteral food through central ̆ or peripheral ̆ venous ̆ access.
It is important to carry out the initial assessment of nutritive risk of the patient. The assessment of nutritive risk is carried out during the first 48 h after arrival of the patient in OITR and further daily. For assessment of nutritive risk use scales of NRS-2002 (Nutritional Risk Scoring) or NUTRIC (Nutrition Risk in the Critically Ill Score) and also determine the body mass index (BMI). Patients with low nutritive risk (for example, on a scale of NRS-2002 3 less points or on NUTRIC 5 scale less points) who for some reason cannot independently eat food, do not demand the therapy specialized ̆ nutritive ̆ during the first ̆ weeks of hospitalization in OITR. For maintenance of the normal nutritive status at such patients it is necessary to renew usual ̆ meal at the first ̆ opportunities.
For high-quality nutritive support of patients with a koronavirusny infection it is necessary to observe the following principles of nutritive therapy:
Nutritive therapy reduces quantity a complication ̆, the over-all mortality also is improved by a disease outcome;
The enteroalimentation is more preferable than parenteral food; at patients with high nutritive risk the enteroalimentation improves the forecast, leads to decrease in quantity nozokomialny infections ̆, total a complication ̆ and lethality;
Parenteral food has to be appointed only after all approaches directed to optimization of an enteroalimentation were used (including nazoyeyunalny feeding, prokinetics and so on);
At receipt in OITR it is necessary to carry out the assessment of nutritive risk, calculation of power requirements ̆ and requirements ̆ in protein;
It is necessary to begin an enteroalimentation during 24–48 h after receipt in OITR with the maximum increase in volume of food by the end of the first ̆ weeks of stay in OITR;
It is necessary to undertake measures for reduction of risk of aspiration and improvement of shipping of food (use of prokinetics, the prolonged administration of nutritious mixes ̆, processing of an oral cavity solution of a hlorgeksidin, raising of the head end of a bed, change of level of receipt of food — delivery nutritious ̆ mixes in a stomach or a small bowel if necessary);
In OITR it is recommended to develop and use enteroalimentation algorithms in work;
It is not necessary to use value of residual volume of gastric contents as the main marker of shipping of an enteroalimentation;
The early beginning of parenteral food is admissible at patients with high nutritive risk or at patients with deficiency of food at whom it is impossible to begin an enteroalimentation.
Nutritive therapy in the form of an early enteroalimentation has to be begun during the first 24–48 h after arrival of the patient in OITR if the patient cannot independently eat food. The decision on the beginning of an enteroalimentation does not require existence of signs of a vermicular movement of intestines (auskultativny signs of intestinal noise, existence of a chair). The enteroalimentation stimulates work of intestines as in the absence of nutrients in intestines secretion of hormones prokinetics (gastrin, bombesin, motilin) decreases.
At unstable ̆ to a hemodynamics the beginning of an enteroalimentation is postponed until stabilization of a condition of the patient. Purpose of an enteroalimentation at patients with angiotonic ̆ support ̆ and arterial ̆ hypotension ̆ (Adsr less than 50 mm Hg.) increases risk of ischemia or reperfusion injury of intestines, adversely vozdeistvut on microcirculation (up to development of a necrosis of intestines). At steadily low ̆ or umenshayushcheisya angiotonic ̆ support the beginning of an enteroalimentation is not contraindicated to patients.