Even in minimal morphological changes in the gut of critically ill patients, its ability to absorb nutrients, drugs and, in particular, acetaminophen is reduced. The search for a simple and accessible clinical method that allows to assess the possibility of enteral nutrition is rather actual. Objectives. To assess the prognostic value of the acetaminophen enteral absorption test in critically ill patients. Materials and methods. A single-center, prospective study was performed in 52 patients of the polyvalent intensive care unit (ICU). 0.5 g of paracetamol was injected into the nasogastric tube. After 10, 15, 20, 30, 40, 50 and 90 minutes 5 ml of venous blood was taken to determine the concentration of acetaminophen in it. On the next day the volume of administered and excreted via a nasogastric tube was recorded. Healthy volunteers (n = 12) were included in group 1. The second group (n = 15) - a positive balance by the nasogastric tube, the third group (n = 15) - the balance is negative up to 500 ml per day, the fourth - negative up to 1 liter per day, the fifth group - negative > 1 liter per day. To identify the predictive value and cutoff values of the test, the data were analyzed using the logistic regression method, and then the ROC analysis. The authors received permission from the local ethics committee. Results. The most informative time interval for determining the concentration of paracetamol in the blood after its administration into the stomach is the interval from 15 to 30 minutes. A strong correlation (r = 0.846 p < 0.001]) was found out between the results of the paracetamol test and the daily balance by the nasogastric tube. ROC analysis showed that the sensitivity of this test exceeds 86 %, and the specificity was about 75 %. If the concentration of paracetamol in the blood is > 6.17 |ig/ml successful total enteral nutrition is highly possible. The values of this indicator in the range from 2.47 |ig/ml to 6.17 |ig/ml can serve as the basis for the implementation of the method of partial enteral nutrition. We believe that at levels < 2.47 mcg/ml, a “minimal enteral nutrition” attempt can be made. Conclusion. The paracetamol absorption test in critically ill patients can be considered as an independent predictor of the feasibility of enteral zone feeding. Predicting enteral feeding intolerance using the paracetamol absorption test in critically ill patients can significantly improve the efficacy and safety of tube feeding method.

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И н ф е к ц и о н н ы е о с л о ж н е н и я. С е п с и с Цель исследования-определить закономерности нарушений биоритмов обмена железа и пероксидации липидов при сепсисе и разработать критерии для прогнозирования исходов гнойно септических осложнений. Материал и мето ды. Обследовано 117 больных с благоприятным исходом течения сепсиса и при его осложнении ПОН и 108 здоровых мужчин (контрольная группа). Изучена суточная динамика концентрации общего и двухвалентного железа в сыво ротке крови и моче, ОЖСС, малонового диальдегида, МСМ 260 и МСМ 280 в сыворотке крови, моче и эритроцитах. Ре зультаты показали, что десинхроноз обмена железа при благоприятном течении сепсиса обусловлен ростом концен трации Fe 2+ , МДА и усилением протеолиза. Установлено, что в прогнозировании благоприятного исхода сепсиса важная роль принадлежит процессам детоксикации МСМ и элиминации МСМ почками. При неблагоприятном тече нии сепсиса и его осложении ПОН значительный рост мезоров Fe 2 , МДА и МСМ сопровождается инверсией их рит мов и снижением экскреции МСМ вследствие прогрессирующей острой почечной недостаточности. Заключение. Ус тановлено, что десинхроноз метаболизма железа обусловлен интенсивным приростом его свободной фракции, инициирующей ПОЛ и мембранодеструктивные процессы. На этой основе разработан способ прогнозирования тече ния сепсиса и его осложнений полиорганной дисфункцией, что позволяет существенно снизить риск развития ослож нений и летальность при гнойно септических процессах. Ключевые слова: биоритмы, обмен железа, липопероксида ция, сепсис, эндотоксикоз, полиорганная недостаточность. Objective: to define the mechanisms of impaired biological rhythms of iron exchange and lipid peroxidation (LPO) and to develop criteria for predicting the outcomes of pyoseptic complications. Subjects and methods. A hundred and seventeen patients with a good course of sepsis and its complication as multiple organ dysfunction (MOD) (a study group) and 108 healthy males (a control group) were examined. Twenty four changes in the concentrations of total and ferrous iron (Fe 2+) in the serum and urine, in those of OZhSS, malonic dialdehyde (MDA), MSM 260 and MSM 280 in the serum, urine, and red blood cells were studied. Results. With the good course of sepsis, iron exchange desynchronism was shown to be caused by elevated Fe 2+ and MDA concentrations and enhanced proteolysis. The processes of renal MSM detoxification and elimina tion were ascertained to play an important role in the prediction of a good outcome of sepsis. With the poor course of sepsis and its complication as MOD, considerable rises in Fe 2+ , MDA, and MSM mesors were followed by their rhythm inversion and diminished MSM excretion due to progressive acute renal failure. Conclusion. The desynchronized exchange of iron was found to be due to the intensive increase in its fraction that triggers LPO and membrane destructive processes. On this basis, the authors have developed a procedure for predicting the course of sepsis and its complication as MOD, which allows the risk of compl...

The purpose of the study was to assess the dependence of development of enteral nutrition intolerance on the disease form and condition severity during early AP with severe progression predictors. Materials and Methods. An open randomized controlled study has been carried out. The study included 64 patients, 31 of them having a severe and 33 — moderately severe forms of the disease. The criteria of enteral nutrition intolerance were: discharge via the nasogastric tube > 500ml simultaneously or > 500 ml/day, compared to the amount fed enterally over 24hrs; aggravation of pain; abdominal distension, diarrhea, nausea and vomiting. Indices possessing a predictive value were identified with the help of logit regression. The null hypothesis was rejected at p<0.05.Results. The APACHE-II score (OR — 1.134, 95% CI: 1.068-1.2, p=0.01) and CPR concentration (OR — 1.006, 95% CI: 1.005-1.013, p=0.001) affect independently the development of a large gastric residual volume. The fact of surgery predicts large gastric residual volumes (OR — 1.821, 95% CI: 2.529-9.19, p=0.001), nausea and vomiting (OR — 2.077, 95% CI: 1.075-4.012, p=0.021). The SOFA score is associated with large gastric residual volumes (OR — 1.349, 95% CI: 1.18-1.539, p= 0.001), pain (OR — 1.203, 95% CI: 1.065-1.364, p= 0.003), nausea and vomiting (OR — 1.167, 95% CI: 1.028-1.324, p= 0.018). The moderately severe form is accompanied with a lower incidence of large gastric residual volumes (OR — 0.354, 95% CI: 0.201-0.611, p=0.001), pain (OR — 0.475, 95% CI: 0.284-0.795, p=0.004), nausea and vomiting (OR — 0.519, 95% CI: 0.304-0.888, p=0.018), and abdominal distension (OR — 0.342, 95% CI: 0.193-0.607, p=0.001). Conclusions. The development and severity of early enteral nutrition intolerance during early acute pancreatitis with severe progression predictors depend on the severity of condition (APACHE-II), extent of multiple organ dysfunction (SOFA), the fact of surgery, form of the disease, and C-reactive protein concentration. A combined use of independent factors increases their predictive value.