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

Relevance. Epidemiological studies indicate an extremely high incidence of traumatic brain injury (TBI) in Russia, Europe and the USA. The main cause of TBI is road traffic injuries. Chronic catabolic processes, typical for patients with long-term impairment of consciousness due to TBI, can interfere with the recovery process and improvement of the functional state of the brain. The organization of nutrition for this category of patients requires an individual approach based on calculations of metabolic needs, as well as timely and adequate substrate supply of nutrients.

Intention. To evaluate the effectiveness of specialized nutritional supplements for enteral nutrition vs pureed diet and to develop technologies for nutritional support for victims in emergencies with a long-term impairment of consciousness due to TBI.

Methodology. Between 2016 and 2020, in the Department of Physical and Rehabilitation Medicine of the Nikiforov Russian Center of Emergency and Radiation Medicine the study included 126 patients with long-term impairment of consciousness due to TBI. The main group (n = 84) received specialized nutritional supplements for enteral nutrition, the control group (n = 42) – a pureed diet. Evaluation of the effectiveness of specialized nutritional supplements for enteral nutrition and a pureed diet was carried out, followed by the development of nutritional support technology for victims of emergencies with long-term impairment of consciousness due to TBI.

Results and Discussion. The data obtained indicated the effectiveness of nutritional support with specialized nutritional supplements for enteral nutrition in comparison with a pureed diet. Statistically significant differences were revealed when comparing trophological status indicators depending on the types of food provided (BMI (p = 0.03), shoulder circumference (p < 0.001), shoulder muscle circumference (p < 0.001), deviation of the actual body weight from the recommended body weight (p = 0.03), total serum protein (p < 0.001), serum albumin (p < 0.001), absolute lymphocyte count (p = 0.03)). A significant decrease in the number of patients with moderate and severe protein-energy malnutrition (PEM) (p = 0.013) in the main group was revealed.

Conclusion. The proposed algorithms and scientifically grounded technologies of nutritional support for victims of emergencies with long-term impairment of consciousness due to TBI, which are based on the assessment of the effectiveness of specialized nutritional supplements for enteral nutrition and a standard hospital pureed diet help to diagnose malnutrition, realize feeding and improve indicators of the trophological status.

1. Vainshenker Yu.I., Ivchenko I.M., Tsinzerling V.A. [et al.]. Infektsionnye faktory povrezhdeniya golovnogo mozga pri dlitel’nykh bessoznatel’nykh sostoyaniyakh [Infectious factors of the brain damage in the long-term unconscious states]. Annaly klinicheskoi i eksperimental’noi nevrologii [Annals of clinical and experimental neurology]. 2014. Vol. 8, N 3. Pp. 21–29. (In Russ.)

2. Kondrat’eva E.A. Vegetativnoe sostoyanie (etiologiya, patogenez, diagnostika i lechenie) : monografiya [Vegetative state (etiology, pathogenesis, diagnosis and treatment) : monograph]. Sankt-Peterburg. 2014. 361 p. (In Russ.)

3. Leiderman I.N., Belkin A.A., Rakhimov R.T. [et al.]. Vliyanie vertikalizatsii na dinamiku pokazatelya energopotrebnosti pokoya u patsientov s sindromom bezotvetnogo bodrstvovaniya [The influence of verticalization on the dynamics of the energy demand at rest in patients with unresponsive wakefulness syndrome]. Zhurnal im. N.V. Sklifosovskogo Neotlozhnaya meditsinskaya pomoshch’ [Russian Sklifosovsky Journal of Emergency Medical Care]. 2020. Vol. 9, N 3. Pp. 356–362. DOI: 10.23934/2223-9022-2020-9-3-356-362. (In Russ.)

4. Luft V.M., Afonchikov V.S, Dmitriev A.V. [et al.]. Rukovodstvo po klinicheskomu pitaniyu: monografiya [Clinical nutrition guide : monograph]. Sankt-Peterburg. 2016. 492 p. (In Russ.)

5. Mochalova E.G., Legostaeva L.A., Zimin A.A. [et al.]. Russkoyazychnaya versiya peresmotrennoi shkaly vosstanovleniya posle komy – standartizirovannyi metod otsenki patsientov s khronicheskimi narusheniyami soznaniya [The Russian version of Coma Recovery Scale-revised — a standardized method for assessment of patients with disorders of consciousness]. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova [S.S. Korsakov Journal of Neurology and Psychiatry]. Special issue. 2018. Vol. 118, N 3-2. Pp. 25–31. DOI: 10.17116/jnevro20181183225-31. (In Russ.)

6. Ovsyannikov D.M., Chekhonatskii A.A., Kolesov V.N. [et al.]. Sotsial’nye i epidemiologicheskie aspekty cherepnomozgovoi travmy [Social and epidemiological aspects of craniocerebral trauma (review)]. Saratovskii nauchno-meditsinskii zhurnal [Saratov journal of medical scientific research]. 2012. Vol. 8, N 3. Pp. 777–785. (In Russ.)

7. Firsov S.A. Patogeneticheskie osnovy meditsinskogo obespecheniya pri sochetannoi cherepno-mozgovoi i skeletnoi travme, assotsiirovannoi s alkogol’noi intoksikatsiei [Pathogenetic basics of medical support for combined traumatic brain and skeletal injury associated with alcohol intoxication] : Abstract dissertation PhD Med. Sci. Arkhangel’sk. 2015. 35 p. (In Russ.)

8. Andriessen Т.M., Horn J., Franschman G. [et al.]. Epidemiology, severity classification, and outcome of moderate and severe traumatic brain injury: a prospective multicenter study. J. Neurotrauma. 2011. Vol. 28, N 10. Pp. 2019–2031. DOI: 10.1089/neu.2011.2034.

9. Coronado V.G., McGuire L.C., Sarmiento K. [et al.]. Trends in traumatic brain injury in the U.S. and the public health response: 1995–2009. J. Safety Res. 2012. Vol. 43, N 4. Pp. 299–307. DOI: 10.1016/j.jsr.2012.08.011.

10. Donkin J.J., Vink R. Mechanisms of cerebral edema in traumatic brain injury: therapeutic developments. Curr. Opin. Neurol. 2010. Vol. 23, N 3. Pp. 293–299. DOI: 10.1097/WCO.0b013e328337f451.

11. Giacino J.T., Kalmar K., Whyte J. The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. Archives of physical medicine and rehabilitation. 2004. Vol. 85, N 12. Pp. 2020–2029. DOI: 10.1016/j.apmr.2004.02.033.ё