rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2019-6-62-79rmt-1833Research ArticleОБЗОРЫ И КРАТКИЕ СООБЩЕНИЯREVIEWS & SHORT COMMUNICATIONSМетаболизм микробиоты при критических состояниях (обзор и постулаты)Metabolism of Microbiota in Critical Illness (Review and Postulates)БелобородоваН. В.BeloborodovaNatalia V.

107031, г. Москва, ул. Петровка, д. 25, стр. 2

25 Petrovka Str., Build. 2, 107031 Moscow

nvbeloborodova@yandex.ruНИИ общей реаниматологии им. В. А. Неговского ФНКЦ РРРоссияV. A. Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and RehabilitologyRussian Federation2019241220191566279Copyright © Белобородова Н.В., 20192019Белобородова Н.В.Beloborodova N.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.reanimatology.com/rmt/article/view/1833

В данном обзоре обсуждается вопрос, почему нужно изучать механизмы действия и учитывать метаболизм микробиоты в организме тяжелобольного пациента, и каким образом специалисты в области клинического питания могут принять в этом самое активное участие

При критических состояниях дисрегуляция эндогенных обменных процессов и белково-энергетический дефицит усугубляются изменением направленности метаболических процессов микробиоты. Растет понимание важности изучения микробного метаболизма в общем метаболическом процессе. Перспективность развития этого направления для повышения эффективности лечения в реаниматологии и успешной реабилитации пациентов очевидна.

Существующие международные рекомендации по интенсивной терапии со временем могут быть пересмотрены в связи с появлением новых научных данных о механизмах критических состояний, связанных с метаболической активностью микробиоты человека. Идет поиск способов активного управления метаболическими процессами через подчинение метаболизма бактерий интересам хозяина. И антимикробные, и биопрепараты (пребиотики, метабиотики) в перспективе будут применяться целенаправленно, под контролем ключевых микробных метаболитов, с использованием доступных методов лабораторного мониторинга.

На основе данных литературы и результатов собственных исследований автор формулирует постулаты о метаболизме микробиоты при критических состояниях, вводит понятия «дисфункции невидимого органа» и «сигнальных молекул бактерий», отвечает на вопрос «что делать?» и в качестве интегрального показателя предлагает использовать ряд микробных метаболитов ароматических аминокислот.

This article discusses the importance of eliciting the mechanisms of action and the metabolism of microbiota in the critically ill patients, as well as the role of nutrition specialist in the management of these patients.

In critically ill patients the impaired regulation of endogenous metabolic processes and protein-energy deficiency are aggravated by abnormal microbiota metabolic processes. There is growing awareness of the importance of studying microbial metabolism in the general metabolic process. Its implications for the improved efficacy of treatment in critical care and rehabilitation are obvious.

Current international intensive care guidelines are being constantly revised in response to the new research data available on the mechanisms of critical illness. The course of the latter may significantly associate with the metabolic activity of human microbiota. Active management of metabolic processes is being sought through the subordination of bacterial metabolism to the interests of the host. Both antimicrobial and bioformulations (prebiotics, metabiotics) will be used in the long term in a targeted manner with the control of key microbial metabolites through available laboratory monitoring tools.

Based on the literature data and the original research, the author formulates postulates of the microbiota metabolism in critical illness, introduces the concepts of «invisible organ dysfunction» and «signaling bacterial molecules», offers answers to the eternal «what is to be done?» question and suggests using a number of microbial aromatic amino acids metabolites as an integral indicator of a course of critical illness.

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The authors declare that there are no conflicts of interest present.