Синдром последствий интенсивной терапии
https://doi.org/10.51922/2074-5044.2025.4.79
Аннотация
Синдром последствий интенсивной терапии (PICS-CCI) возникает у тех пациентов реанимационных отделений, которые выжили после перенесенного критического состояния, если длительность лечения в таких отделениях превышала более 14 дней и сопровождалась органной дисфункцией. Следует отметить, что помимо крайне низких показателей долгосрочной реабилитации, у них также значительно снижены физические функции, связанные со здоровьем по сравнению с другими пациентами.
Цель работы: проанализировать данные литературных источников, затрагивающих вопросы таких хронических критических состояний, как синдром последствий интенсивной терапии; подчеркнуть необходимость дальнейшего мультидисциплинарного подхода в изучении данного феномена, а также в ведении и лечении такой категории пациентов, что будет способствовать увеличению процента выживаемости и улучшению качества жизни пациентов с PICS-CCI.
Об авторах
А. М. ДзядзькоБеларусь
Н. И. Лендин
Беларусь
В. В. Нестеров
Беларусь
Д. Д. Нестерова
Беларусь
А. Г. Кадушкин
Беларусь
С. Н. Шубина
Беларусь
Список литературы
1. Парфёнов, А. Л. Хроническое критическое заболевание: современные аспекты проблемы (обзор) / А. Л. Парфёнов, В. П. Разживин, М. В. Петрова // СТМ. 2022. Т. 14, № 3. С. 70–83.
2. R osenthal, M. D. Chronic Critical illness and PICS Nutritional Strategies / M. D. Rosenthal, E. L. Vanzant, F. A. Moore // Journal of Clinical Medicine. 2021. № 10. Mode of access: https://doi.org/10.3390/jcm10112294. Date of access: 10.04.2025.
3. Rosenthal, M. D. Persistent, Immunosuppression, Inflammation, Catabolism Syndrome and Diaphragmatic Dysfunction / M. D. Rosenthal [et al.] // Current Pulmonology Reports. 2017. № 6. P. 54–57.
4. Hawkins, R. B. Chronic Critical Illness and the Persistent Inflammation, Immunosuppression, and Catabolism Syndrome / R. B. Hawkins [et al.] // Frontiers in Immunology. 2018. № 9. Mode of access: https://doi/10.3389/fimmu.2018.01511. Date of access: 10.04.2025.
5. Horn, D. L. Persistent metabolomic alterations characterize chronic critical illness after severe trauma / D. L. Horn [et al.] // Journal of Trauma and Acute Care Surgery. 2021. Vol. 90, № 1. P. 35–45.
6. Rosenthal, M. D. Chronic Critical Illness Patients Fail to Respond to Current Evidence-Based Intensive Care Nutrition Secondarily to Persistent Inflammation, Immunosuppression, and Catabolic Syndrome / M. D. Rosenthal [et al.] // JPEN. 2020. Vol. 44, № 7. P. 1237–1249.
7. Mikkelsen, M. E. Post-intensive care syndrome (PICS) in adults: Clinical features and diagnostic evaluation [Electronic resource] / M. E. Mikkelsen, G. Netzer, T. Iwashyna // UpToDate. Mode of access: https://www.uptodate.com/contents/post-intensivecare-syndrome-pics-in-adults-clinical-featuresand-diagnostic-evaluation/print. Date of access: 10.04.2025.
8. Marra, A. Cooccurrence of Post-Intensive Care Syndrome Problems Among 406 Survivors of Critical illness / A. Marra [et al.] // Critical Care Medicine. 2018. Vol. 46, № 9. P. 1393–1401.
9. Белкин, А. А. Синдром последствий интенсивной терапии (ПИТ-синдром) / А. А. Белкин // Вестник интенсивной терапии имени А. И. Салтанова. 2018. № 2. С. 12–23.
10. Marshall, J. C. Critical illness is an iatrogenic disorder / J. C. Marshall // Critical Care Medicine. 2010. Vol. 38, № 10. –P. 582–589.
11. Андрейченко, С. А. Синдром приобретенной в ОРИТ слабости у больных с дыхательной недостаточностью / С. А. Андрейченко [и др.] // Клиническая практика. 2021. Т. 12, № 2. С. 5–13.
12. Mankowski R. T. Pathophysiology and Treatment Strategies of Acute Myopathy and Muscle Wasting after Sepsis / R. T. Mankowski [et al.] // Journal of Clinical Medicine. 2021. Mode of access: https://doi.org/10.3390/jcm10091874. Date of access 10.04.2025.
13. He, X. Post intensive care syndrome: A review of clinical symptoms, evaluation, intervention / X. He [et al.] // Heliyon. 2024. № 10. Mode of access: https://doi.org/10.1016/j.heliyon.2024.e31278. Date of access: 10.04.2025.
14. Плотников, Г. П. Полинейромиопатия критических состояний (обзор литературы) / Г. П. Плотников [и др.] // Вестник анестезиологии и реаниматологии. 2023. Т. 20, № 5. С. 76–83.
15. Panahi, A. The Prevalence and Outcome of Intensive Care Unit Acquired Weakness (ICUAW) / A. Panahi [et al.] // Tanaffos. 2020. Vol. 19, № 3. P. 250–255.
16. Belkin, A. A. , Alasheev, A. M. Correlation links between the length of peripheral nerves and the rate of their involvement into critical illness polyneuropathy (CIMP) / A. A. Belkin, A. M. Alasheev // European Journal of Anesthesiology. 2005. № 22. P. 15–16.
17. Stevens, R. D. A framework for diagnosing and classifying intensive care unit-acquired weakness / R. D. Stevens [et al.] // Critical Care Medicine. 2009. Vol. 37, № 10. P. 299–308.
18. Vollenweider, R. Passive motion of the lower extremities in sedated and ventilated patients in the ICU a systematic review of early effects and replicability of Interventions / R. Vollenweider [et al.] // PLoS One. 2022. Vol. 17, № 5. Mode of access https://doi/10.1371/journal.pone.0267255. Date of access: 10.04.2025.
19. Liu, Y. The role of NLRP3 inflammasome in inflammation-related skeletal muscle atrophy / Y. Liu [et al.] // Frontiers in Immunology. 2022. Vol. 13. Mode of access: https://doi/10.3389/fimmu.2022.1035709. Date of access: 10.04.2025.
20. Latronico, N. The ICM research agenda on intensive care unit-acquired weakness / N. Latronico [et al.] // Intensive Care Medicine. 2017. Vol. 43, № 9. P. 1270–1281.
21. Brodsky, M. B. Recovery of Dysphagia Symptoms after Oral Endotracheal Intubation in ARDS Survivors: A 5-Year Longitudinal Study / M. B. Brodsky [et al] // Annals of the American Thoracic Society. 2017. Vol.14, № 3. P. 376–383.
22. Lynch, Y. T. The accuracy of the bed side swallowing evaluation for detecting aspiration in survivors of acute respiratory failure / Y. T. Lynch [et al.] // Journal of Critical Care. 2017. № 39. P. 143–148.
23. Kim, M. J. Associations between prolonged intubation and developing post-extubation dysphagia and aspiration pneumonia in non-neurologic critically ill patients / M. J. Kim [et al.] // Annals of Rehabilitation Medicine. 2015. Vol. 39, № 5. P. 763–771.
24. Malandraki, G. A. Postextubation Dysphagia in Critical Patients: A First Report from the Largest Step-Down Intensive Care Unit in Greece / G. A. Malandraki [et al.] // American Journal of Speech-Language Pathology. 2016. Vol.25, № 2. P. 150–156.
25. Inoue, S. Post-intensive care syndrome: its pathophysiology, prevention, and future directions / S. Inoue [et al.] // Acute Medicine & Surgery. 2019. № 6. P. 233–246.
26. Sakusic, A. Potentially Modifiable Risk Factors for Long-Term Cognitive Impairment After Critical Illness: A Systematic Review / A. Sakusic [et al.] // Mayo Clinic Proceedings. 2018. Vol. 93, № 1. P. 68–82.
27. Kim, I-Y. The anabolic response to a meal containing different amounts of protein is not limited by the maximal stimulation of protein synthesis in healthy young adults / I-Y. Kim [et al.] // American journal of physiology. Endocrinology and metabolism. –2016. № 310. P. 73–80.
28. Landi, F. Muscle loss: the new malnutrition challenge in clinical practice / F. Landi [et al] // American journal of Clinical Nutrition. 2019. Vol. 38, № 5. P.2113–2120.
29. McClave, S. A. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A. S.P. E.N.) / S. A. McClave [et al.] // JPEN. 2016. № 40. P. 159–211.
30. Deutz, N. E ., Wolfe, R. R. Is there a maximal anabolic response to protein intake with a meal? / N. E. Deutz, R. R. Wolfe // American journal of Clinical Nutrition. 2013. № 32. P. 309–313.
31. Hurt, R. T. Summary Points and Consensus Recommendations from the International Protein Summit / R. T. Hurt [et al.] // Nutrition in Clinical Practice. 2017. № 32. P. 142–151.
32. Jones, C. Improving rehabilitation after critical illness through outpatient physiotherapy classes and essential amino acid supplement: a randomized controlled trial / C. Jones [et al.] // Journal of Critical Care. 2015. № 30. P. 901–907.
33. Dijoia, B. D. Dysregulated Immunity and Immunotherapy after Sepsis / B. D. Dijoia [et al.] // Journal of Clinical Medicine. 2021. Vol. 10, № 8. Mode of access: https://doi.org/10.3390/jcm10081742. Date of access: 10.04.2025.
34. Lillian, H. Persistent Inflammation, Immunosuppression and Catabolism Syndrome (PICS) after Polytrauma: A Rare Syndrome with Major Consequences / H. Lillian [et al.] // Journal of Clinical Medicine. 2020. Vol. 9, № 1. Mode of access: https://doi.org/10.3390/jcm9010191. Date of access: 10.04.2025.
35. Hiroyuki, H. Innate Immunity in the Persistent Inflammation, Immunosuppression, and Catabo lism Syndrome and Its Implications for Therapy / H. Hiroyuki [et al.] // Frontiers in Immunology. 2018. № 9. Mode of access: https://doi.org/10.3389/fimmu.2018.00595. Date of access: 10.04.2025.
36. Rosenthal, M. D. Chronic critical illness: application of what we know / M. D. Rosenthal [et al.] // Nutrition in Clinical Practice . 2018. № 33. P. 39–45.
37. Rivera, A. Innate cell communication kickstarts pathogen-specific immunity / A. Rivera [et al.] // Nature Immunology. 2016. № 17. P. 356–363.
38. Fleshner, M ., Crane, C. R. Exosomes, DAMPs and miRNA: Features of stress physiology and immune homeostasis / M. Fleshner, C. R. Crane // Trends Immunology. –2017. № 38. P. 768–776.
39. Kang, J-W. DAMPs activating innate immune responses in sepsis / J-W. Kang [et al.] // Ageing Research Reviews. 2015. № 24. P. 54–65.
40. Maslanik, T. The inflammasome and danger associated molecular patterns (DAMPs) are implicated in cytokine and chemokine responses following stressor exposure / T. Maslanik [et al.] // Brain, Behavior and Immunity. 2013. № 28. P. 54–62.
41. Fleshner, M. Stress-evoked sterile inflammation, danger associated molecular patterns (DAMPs), microbial associated molecular patterns (MAMPs) and the inflammasome / M. Fleshner // Brain, Behavior and Immunity. 2013. № 27. P. 1–7.
42. Hu, Q. Elevated levels of plasma mitochondrial DNA are associated with clinical outcome in intraabdominal infections caused by severe trauma / Q. Hu [et al.] // Surgery Infection. 2017. № 18. P. 610–618.
43. Timmermans, K. Plasma nuclear and mitochondrial DNA levels, and markers of inflammation, shock, and organ damage in patients with septic shock / K. Timmermans[et al.] // Shock. 2016. № 45. P. 607–612.
44. Ingels, C. Soluble RAGE and the RAGE ligands HMGB1 and S100A12 in critical illness: Impact of glycemic control with insulin and relation with clinical outcome / C. Ingels [et al.] // Shock. 2015. № 43. P. 109–116.
45. Achouiti, A. S100A12 and soluble receptor for advanced glycation end products levels during human severe sepsis / A. Achouiti [et al.] // Shock. 2013. № 40. P. 188–194.
46. Picca, A. Circulating Mitochondrial DNA at the Crossroads of Mitochondrial Dysfunction and Inflammation During Aging and Muscle Wasting Disorders / A. Picca [et al.] // REJUVENATION RESEARCH. 2018. Vol. 21, № 4. P. 350–359.
47. Mira, J. C. Sepsis pathophysiology, chronic critical illness, and persistent inflammation-immunosuppression and catabolism syndrome / J. C. Mira [et al.] // Critical Care Medicine. 2017. № 45. P. 253–262.
Рецензия
Для цитирования:
Дзядзько А.М., Лендин Н.И., Нестеров В.В., Нестерова Д.Д., Кадушкин А.Г., Шубина С.Н. Синдром последствий интенсивной терапии. Военная медицина. 2025;(4):79-89. https://doi.org/10.51922/2074-5044.2025.4.79
For citation:
Dzyadzko A.M., Lendin N.I., Nesterov V.V., Nesterova D.D., Kadushkin A.G., Shubina S.N. Intensive care outcomes syndrome (review). Military Medicine. 2025;(4):79-89. (In Russ.) https://doi.org/10.51922/2074-5044.2025.4.79
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