SAFETY OF MIXED ARTIFICIAL NUTRITION IN PATIENTS WITH SEVERE MULTISYSTEM CRANIOCEREBRAL TRAUM

ABSTRACT. Early initiation of artificial nutrition is one of the important components of intensive care for those affected with SMCT. The priority is given to enteral nutrition (EN). Parenteral nutrition (PN) is indicated in order to cover estimated needs in various substrates when EN cannot be performed or is inadequate. However, it must be taken into account that in addition to positive effects, PN may be followed by a number of complications: hyperglycemia, hypertriglyceridemia, impaired pulmonary function, increased thrombogenesis..

PURPOSE OF THE STUDY. To assess the safety of PN, used as a component of mixed artificial nutrition in victims with SMCT.

MATERIAL AND METHODS. Twenty patients with SMCT, conscious state up to GCS 6-13 and severity of the condition ISS 30-55 upon admission were examined. The age of victims was 40.2±13.1 years, the ratio of men/women was 17/3. All the victims had the diagnosis of brain contusion. In 9 patients, acute subdural hematomas were revealed. They underwent decompressive craniotomy and hematoma removal. The energy consumption was calculated using the Harris-Benedict equation with correction coefficients and indirect calorimetry (IC) method. IC was performed 24 hours a day also calculating respiratory coefficient. Nitrogen balance was studied to assess the severity of hypercatabolism. Enteral nutrition was initiated in all victims starting from day 2 after the injury. In connection with the impossibility of complete compensation of protein-energy requirements by EN, on day 8.8±1.3, PN was added. A three-component mixture of Nutriflex Lipid 70/180 (B. Braun, Germany), 625 ml was used. The concentration of triglycerides (TG) and glucose in venous blood plasma was assessed daily, as well as the ratio of oxygen tension in the arterial blood to the oxygen fraction in the inhaled mixture (PaO2 /FiO2 ).

RESULTS. All patients had hypercatabolism prior to initiation of mixed artificial nutrition, and its severity lowered when mixed artificial nutrition was initiated (on day 3 of artificial nutrition in 11 patients, on day 5 in 3 patients and by day 7 in 6 patients). The introduction of PN “three in one” mixture was accompanied by a slight increase in the concentration of TG 2 hours after the start of the infusion and did not affect the dynamics of pulmonary gas exchange. The introduction of PN was accompanied by the development of hyperglycemia. The increase of glucose in venous blood serum was noted 2 and 12 hours after the onset of PN.

CONCLUSION. Mixed artificial nutrition in patients with severe multisystem craniocerebral trauma does not lead to the development of hypertriglyceridemia and violation of pulmonary gas exchange and allows to achieve nutritional therapy goals.

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