Ivan S. Klyuev

Nutritional support is a critical component of intensive care for patients with abdominal sepsis. This paper systematizes modern methods for assessing metabolic status (anthropometric, laboratory, and instrumental) and determining daily energy requirements (calculation equations, fixed standards, and indirect calorimetry). It is demonstrated that an optimal strategy requires a comprehensive, personalized approach with priority use of indirect calorimetry as the «gold standard» for determining energy expenditure. Practical recommendations for the selection of assessment methods and the frequency of nutritional status monitoring in patients in intensive care units are developed.

This article is devoted to current approaches to non-invasive ventilation (NIV) and methods of respiratory rehabilitation in patients with acute respiratory failure (ARF). Data from domestic and international studies over the past 10 years are systematized, covering the physiological basis of NIV, a comparative analysis of interfaces, as well as indications and limitations of the method. Issues of respiratory muscle dysfunction in ARF, methods for its assessment, and possibilities for restoring breathing function using respiratory trainers are considered. The review summarizes research findings demonstrating the potential for integrating NIV and respiratory trainers into the comprehensive management of patients with ARF. The prospects for further investigation of the effectiveness and safety of these approaches in various clinical settings are discussed.

This article is devoted to current approaches to non‑invasive ventilation (NIV) and methods of respiratory rehabilitation in patients with acute respiratory failure (ARF). Data from domestic and international studies over the past 10 years are systematized, covering the physiological basis of NIV, a comparative analysis of interfaces, as well as indications and limitations of the method. Issues of respiratory muscle dysfunction in ARF, methods for its assessment, and possibilities for restoring breathing function using respiratory trainers are considered. The review summarizes research findings demonstrating the potential for integrating NIV and respiratory trainers into the comprehensive management of patients with ARF. The prospects for further investigation of the effectiveness and safety of these approaches in various clinical settings are discussed.

Treatment of hypoxemic acute respiratory failure remains one of the urgent and applied problems of modern intensive care, as it is the leading cause of critical conditions and high mortality in patients in intensive care units. Patient self-inflicted lung injury plays a special role in maintaining and worsening respiratory failure, which can develop under any method of respiratory support. A number of studies in recent years have demonstrated significant clinical effectiveness of non-invasive respiratory support compared to traditional mechanical ventilation. Due to this, the concept of respiratory failure treatment has changed in favor of more active use of non-invasive ventilation and high-flow oxygen therapy. However, their rational and personalized use remains a labor-intensive task due to the polymorphism of clinical manifestations, diversity of etiological factors and pathogenetic mechanisms of respiratory disorders. The purpose of this publication is to review the literature data on the use of non-invasive respiratory support methods at different stages of hypoxemic acute respiratory failure treatment. The first part will consider the current mechanisms of development of patient self-inflicted lung injury and the general characteristics of noninvasive ventilation and high-flow oxygen therapy.

Timely and adequate nutritional support is on a par with etiotropic and pathogenetic therapy in terms of effectiveness, especially in intensive care patients. Critical condition and systemic inflammation of any etiology lead not only to primary and secondary damage to organs and tissues, the development of multiple organ failure, but also trigger a cascade of reactions aimed at mobilizing energy substrates to maintain homeostasis and ensure regeneration. This leads to a rapid depletion of endogenous reserves of macro- and microelements and, without proper replenishment, a syndrome of metabolic dysfunction develops, which, in turn, contributes to the progression of multiple organ failure, the development of purulentseptic and metabolic complications, which increases the time of hospitalization and pharmacoeconomical costs, worsens the results of treatment. In everyday clinical practice, when diagnosing nutritional deficiency or the risk of its development, the clinician must determine not only the nutrition program, but also the format of its implementation. This paper presents a critical analysis of the most common ways of providing nutrition and algorithms for personalized choice of nutritional therapy in patients in intensive care units.

Adequate nutritional support for a critically ill patient has been and remains one of the main, complex and not fully resolved problems of modern resuscitation, which, unfortunately, often remains without due attention. In everyday practice, in order to adequately correct nutritional deficiency, the resuscitator must, first of all, correctly assess the trophological status of the patient. Currently, there is a large selection of nutrients and different methods for assessing metabolic status. The paper presents a critical analysis of existing methods for assessing the nutritional status and algorithms for the personalized choice of each of them in a specific clinical situation in critically ill patients.

Adequate nutritional support for critically ill patients has always been (and still remains) one of the main, complex and not fully resolved problems of modern intensive care, which, unfortunately, often remains without due attention. In everyday practice, in order to adequately correct nutritional deficiency, the resuscitator must, first of all, correctly assess the trophological status of the patient. Currently, there exists a large selection of nutrients and different methods for assessing metabolic status. The paper presents a critical analysis of existing methods for assessing the nutritional status and algorithms for the personalized choice of each of them in a specific clinical situation in critically ill patients.