The site of the Media Sphera Publishers contains materials intended solely for healthcare professionals.
By closing this message, you confirm that you are a certified medical professional or a student of a medical educational institution.

Pasechnik I.N.

Central State Medical Academy RF President Affairs Department

Talyzin P.A.

Central State Medical Academy of Administrative Directorate of the President of the Russian Federation;
Zhadkevich Municipal Clinical Hospital

Skobelev E.I.

Central State Medical Academy of Administrative Directorate of the President of the Russian Federation

Nutritional support for intensive care patients: the role of lipid component

Authors:

Pasechnik I.N., Talyzin P.A., Skobelev E.I.

More about the authors

Read: 1828 times


To cite this article:

Pasechnik IN, Talyzin PA, Skobelev EI. Nutritional support for intensive care patients: the role of lipid component. Russian Journal of Anesthesiology and Reanimatology. 2024;(3):58‑66. (In Russ.)
https://doi.org/10.17116/anaesthesiology202403158

Recommended articles:
Nutritional support for sepsis: is there a single concept?. Russian Journal of Anesthesiology and Reanimatology. 2024;(6):70-78
Resting energy expe­nditure asse­ssment needs in patients with pancreatogenic sepsis. Russian Journal of Anesthesiology and Reanimatology. 2025;(3):26-33

References:

  1. Lopez-Fermin J, Escarramán-Martínez D, Flores Ramírez R. Doing More Can Be Worse: Ten Common Errors in the ICU. ICU Management and Practice. 2022;22(1):28-32. 
  2. Ng DHL, Koh FHX, Yeong HEL, Huey TCW, Chue KM, Foo FJ, Chew STH. Nutrition Care after Hospital Discharge in Singapore: Evidence-Based Best-Practice Recommendations. Nutrients. 2023;15(21):4492. https://doi.org/10.3390/nu15214492
  3. Pasechnik IN. Nutritional Support for Critically Ill Patients (Review). General Reanimatology. 2020;16(4):40-59. (In Russ.). https://doi.org/10.15360/1813-9779-2020-4-40-59
  4. Herridge MS, Moss M, Hough CL, Hopkins RO, Rice TW, Bienvenu OJ, Azoulay E. Recovery and outcomes after the acute respiratory distress syndrome (ARDS) in patients and their family caregivers. Intensive Care Medicine. 2016;42(5):725-738.  https://doi.org/10.1007/s00134-016-4321-8
  5. Cotoia A, Umbrello M, Ferrari F, Pota V, Alessandri F, Cortegiani A, De Rosa S. Nutritional support and prevention of post-intensive care syndrome: the Italian SIAARTI survey. Journal of Anesthesia, Analgesia and Critical Care. 2023;3(1):45.  https://doi.org/10.1186/s44158-023-00132-4
  6. Wischmeyer PE. Enteral Nutrition Can Be Given to Patients on Vasopressors. Critical Care Medicine. 2020;48(1):122-125.  https://doi.org/10.1097/CCM.0000000000003965
  7. Singer P, Blaser AR, Berger MM, Calder PC, Casaer M, Hiesmayr M, Mayer K, Montejo-Gonzalez JC, Pichard C, Preiser JC, Szczeklik W, van Zanten ARH, Bischoff SC. ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit. Clinical Nutrition. 2023;42(9):1671-1689. https://doi.org/10.1016/j.clnu.2023.07.011
  8. Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, Hiesmayr M, Mayer K, Montejo JC, Pichard C, Preiser JC, van Zanten ARH, Oczkowski S, Szczeklik W, Bischoff SC. ESPEN guideline on clinical nutrition in the intensive care unit. Clinical Nutrition. 2019;38(1):48-79.  https://doi.org/10.1016/j.clnu.2018.08.037
  9. Compher C, Bingham AL, McCall M, Patel J, Rice TW, Braunschweig C, McKeever L. Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition. Journal of Parenteral and Enteral Nutrition. 2022;46(1):12-41.  https://doi.org/10.1002/jpen.2267
  10. Hill A, Elke G, Weimann A. Nutrition in the Intensive Care Unit — A Narrative Review. Nutrients. 2021;13(8):2851. https://doi.org/10.3390/nu13082851
  11. Gomes F, Schuetz P, Bounoure L. ESPEN guidelines on nutritional support for polymorbid internal medicine patients. Clinical Nutrition. 2018;37(1): 336-353.  https://doi.org/10.1016/j.clnu.2017.06.025
  12. Leyderman IN, Gritsan AI, Zabolotskikh IB, Lebedinskii KM, Krylov KYu, Mazurok VA, Yaroshetsky AI. Metabolic monitoring and nutritional support following long-term mechanical ventilation. Russian Journal of Anesthesiology and Reanimatology. 2022;5:6-17. (In Russ.). https://doi.org/10.17116/anaesthesiology20220516
  13. Leyderman IN, Gritsan AI, Zabolotskikh IB, Mazurok VA, Polyakov IV, Potapov AL, Sytov AV, Yaroshetskiy AI. Perioperative nutritional support. Methodological recommendations of the Federation of Anesthesiologists and Intensive Care Specialists. Annals of Critical Care. 2021;4:7-20. (In Russ.). https://doi.org/10.21320/1818-474X-2021-4-7-20
  14. Ershov VI, Novikova TV. Three main components of initial enteral support for neurological patients in critical illness. Russian Journal of Anesthesiology and Reanimatology. 2023;6:84-90. (In Russ.). https://doi.org/10.17116/anaesthesiology202306184
  15. Berger MM, Reintam-Blaser A, Calder PC, Casaer M, Hiesmayr MJ, Mayer K, Montejo JC, Pichard C, Preiser JC, van Zanten ARH, Bischoff SC, Singer P. Monitoring nutrition in the ICU. Clinical Nutrition. 2019;38(2):584-593.  https://doi.org/10.1016/j.clnu.2018.07.009
  16. Jiang L, Huang X, Wu C. The effects of an enteral nutrition feeding protocol on critically ill patients: A prospective multi-center, before-after study. Journal of Critical Care. 2020;56:249-256.  https://doi.org/10.1016/j.jcrc.2020.01.018
  17. Li Y, Liu H. Application strategy and effect analysis of nutritional support nursing for critically ill patients in intensive care units. Medicine. 2022;101(38):e30396. https://doi.org/10.1097/MD.0000000000030396
  18. Canales C, Elsayes A, Yeh DD, Belcher D, Nakayama A. Nutrition Risk in Critically Ill Versus the Nutritional Risk Screening 2002: Are They Comparable for Assessing Risk of Malnutrition in Critically Ill Patients? Journal of Parenteral and Enteral Nutrition. 2019;43(1):81-87.  https://doi.org/10.1002/jpen.1181
  19. Coruja MK, Cobalchini Y, Wentzel C, Fink JDS. Nutrition Risk Screening in Intensive Care Units: Agreement Between NUTRIC and NRS 2002 Tools. Nutrition in Clinical Practice. 2020;35(3):567-571.  https://doi.org/10.1002/ncp.10419
  20. Rattanachaiwong S, Zribi B, Kagan I, Theilla M, Heching M, Singer P. Comparison of nutritional screening and diagnostic tools in diagnosis of severe malnutrition in critically ill patients. Clinical Nutrition. 2020;S0261-5614(20)30099-6.  https://doi.org/10.1016/j.clnu.2020.02.035
  21. Moonen HPFX, Beckers KJH, van Zanten ARH. Energy expenditure and indirect calorimetry in critical illness and convalescence: current evidence and practical considerations. Journal of the Intensive Care. 2021;9(1):8.  https://doi.org/10.1186/s40560-021-00524-0
  22. Heyland DK, Patel J, Compher C, Rice TW, Bear DE, Lee ZY, González VC, O’Reilly K, Regala R, Wedemire C, Ibarra-Estrada M, Stoppe C, Ortiz-Reyes L, Jiang X, Day AG; EFFORT Protein Trial team. The effect of higher protein dosing in critically ill patients with high nutritional risk (EFFORT Protein): an international, multicentre, pragmatic, registry-based randomised trial. Lancet. 2023;401(10376):568-576.  https://doi.org/10.1016/S0140-6736(22)02469-2
  23. De Waele E, van Zanten ARH. Routine use of indirect calorimetry in critically ill patients: pros and cons. Critical Care. 2022;26(1):123.  https://doi.org/10.1186/s13054-022-04000-5
  24. Van Zanten ARH, De Waele E, Wischmeyer PE. Nutrition therapy and critical illness: practical guidance for the ICU, post-ICU, and long-term convalescence phases. Critical Care. 2019;23:368. 
  25. Koekkoek WACK, van Setten CHC, Olthof LE, Kars JCNH, van Zanten ARH. Timing of PROTein INtake and clinical outcomes of adult critically ill patients on prolonged mechanical VENTilation: The PROTINVENT retrospective study. Clinical Nutrition. 2019;38(2):883-890.  https://doi.org/10.1016/j.clnu.2018.02.012
  26. Pasechnik IN, Zakrevsky AI. Nutritional support and rehabilitation in intensive care units for elderly and senile patients. Literature review. Annals of Critical Care. 2021;2:94-102. (In Russ.). https://doi.org/10.21320/1818-474X-2021-2-94-102
  27. Pasechnik IN, Sirota AE, Talyzin PA, Novikova TV. Features of nutritional support in stress hyperglycemia and diabetes mellitus in the intensive care unit. Russian Journal of Anesthesiology and Reanimatology. 2023;3:59-66. (In Russ.). https://doi.org/10.17116/anaesthesiology202303159
  28. Wischmeyer PE, Bear DE, Berger MM, De Waele E, Gunst J, McClave SA, Prado CM, Puthucheary Z, Ridley EJ, Van den Berghe G, van Zanten ARH. Personalized nutrition therapy in critical care: 10 expert recommendations. Critical Care. 2023;27(1):261.  https://doi.org/10.1186/s13054-023-04539-x
  29. Cintoni M, Mele MC. The Role of Immunonutrition in Patients. Nutrients. 2023;15(3):780.  https://doi.org/10.3390/nu15030780
  30. Tao X, Yang Y, Xu S, Xiong Q. Efficacy of immune nutrients in severe acute pancreatitis: A network meta-analysis. Medicine. 2023;102(43):e35615. https://doi.org/10.1097/MD.0000000000035615
  31. McCarthy MS, Martindale RG. Immunonutrition in Critical Illness: What Is the Role? Nutrition in Clinical Practice. 2018;33(3):348-358.  https://doi.org/10.1002/ncp.10102
  32. Hirschberger S, Schmid A, Kreth S. Immunomodulation by nutritional intervention in critically ill patients. Anaesthesiologie. 2023;72(4):229-244.  https://doi.org/10.1007/s00101-023-01258-4
  33. Pasechnik IN, Gubaidullin RR, Borisov AYu. Osnovy nutritivnoj podderzhki bol’nykh v kriticheskikh sostoyaniyakh. M.: RIA «Kolizej»; 2012. (In Russ.).
  34. Jeyakumar SM, Vajreswari A. Pharmaconutrition strategy to resolve SARS-CoV-2-induced inflammatory cytokine storm in non-alcoholic fatty liver disease: Omega-3 long-chain polyunsaturated fatty acids. World Journal of Clinical Cases. 2021;9(31):9333-9349. https://doi.org/10.12998/wjcc.v9.i31.9333
  35. De Waele E, Malbrain MLNG, Spapen H. Nutrition in Sepsis: A Bench-to-Bedside Review. Nutrients. 2020;12(2):395.  https://doi.org/10.3390/nu12020395
  36. Singer P, Calder PC. The role of omega-3 polyunsaturated fatty acids in the intensive care unit. Current Opinion in Clinical Nutrition and Metabolic Care. 2023;26(2):129-137.  https://doi.org/10.1097/MCO.0000000000000896
  37. Blaauw R, Calder PC, Martindale RG, Berger MM. Combining proteins with n-3 PUFAs (EPA+DHA) and their infammation pro-resolution mediators for preservation of skeletal muscle mass. Critical Care. 2024;28:38.  https://doi.org/10.1186/s13054-024-04803-8
  38. Cagnina RE, Duvall MD, Nijmeh J, Levy BD. Specialized pro-resolving mediators in respiratory diseases. Current Opinion in Clinical Nutrition and Metabolic Care. 2022;25(2):67-74.  https://doi.org/10.1097/MCO.0000000000000805
  39. Saini RK, Keum Y-S. Omega-3 and omega-6 polyunsaturated fatty acids: Dietary sources, metabolism, and significance — A review. Life Science. 2018;203:255-267.  https://doi.org/10.1016/j.lfs.2018.04.049
  40. Schulze MB, Minihane AM, Saleh RNM, Risérus U. Intake and metabolism of omega-3 and omega-6 polyunsaturated fatty acids: nutritional implications for cardiometabolic diseases. Lancet Diabetes and Endocrinology. 2020;8(11):915-930.  https://doi.org/10.1016/S2213-8587(20)30148-0
  41. Djuricic I, Calder PC. Beneficial Outcomes of Omega-6 and Omega-3 Polyunsaturated Fatty Acids on Human Health: An Update for 2021. Nutrients. 2021;13(7):2421. https://doi.org/10.3390/nu13072421
  42. Kapoor B, Kapoor D, Gautam S, Singh R, Bhardwaj S. Dietary Polyunsaturated Fatty Acids (PUFAs): Uses and Potential Health Benefits. Current Nutrition Reports. 2021;10(3):232-242.  https://doi.org/10.1007/s13668-021-00363-3
  43. Oppedisano F, Macrì R, Gliozzi M, Musolino V, Carresi C, Maiuolo J, Bosco F, Nucera S, Caterina Zito M, Guarnieri L, Scarano F, Nicita C, Coppoletta AR, Ruga S, Scicchitano M, Mollace R, Palma E, Mollace V. The Anti-Inflammatory and Antioxidant Properties of n-3 PUFAs: Their Role in Cardiovascular Protection. Biomedicines. 2020;8(9):306.  https://doi.org/10.3390/biomedicines8090306
  44. Simopoulos AP. The importance of the ratio of omega-6/omega-3 essential fatty acids. Biomedecine and Pharmacotherapie. 2002;56(8):365-379.  https://doi.org/10.1016/s0753-3322(02)00253-6
  45. Heller AR, Rössler S, Litz RJ, Stehr SN, Heller SC, Koch R, Koch T. Omega-3 fatty acids improve the diagnosis-related clinical outcome. Critical Care Medicine. 2006;34(4):972-979.  https://doi.org/10.1097/01.CCM.0000206309.83570.45
  46. Martin JM, Stapleton RD. Omega-3 fatty acids in critical illness. Nutrition Reviews. 2010;68(9):531-541.  https://doi.org/10.1111/j.1753-4887.2010.00313.x
  47. Darwesh AD, Bassiouni W, Sosnowski DK, Seubert JM. Can N-3 polyunsaturated fatty acids be considered a potential adjuvant therapy for COVID-19-associated cardiovascular complications? Pharmacology and Therapeutics. 2021;219:107703. https://doi.org/10.1016/j.pharmthera.2020.107703
  48. Zhang Y, Guo H, Liang J, Xiao W, Li Y. Relationship between Dietary Omega-3 and Omega-6 Polyunsaturated Fatty Acids Level and Sarcopenia. A Meta-Analysis of Observational Studies. Frontiers in Nutrition. 2022;8:738083. https://doi.org/10.3389/fnut.2021.738083
  49. Lomivorotov VV, Efremov SM, Abubakirov MN, Stoppe Ch. Is there any place left for omega-3 fatty acids in cardiac surgery? Messenger of Anesthesiology and Resuscitation. 2017;14(3):51-57. (In Russ.). https://doi.org/10.21292/2078-5658-2017-14-3-51-57
  50. Vijai KSS. Correcting ω6/ω3 Ratio through Combating Oxidation is the Key to the Success for Better Health. Annals of Reviews and Research. 2018;2(4): 555591.
  51. Kazuo M. Prevention of Fish Oil Oxidation. Journal of Oleo Science. 2019; 68(1):1-11.  https://doi.org/10.5650/jos.ess18144
  52. Yang A, Wu Y, Yu G, Wang H. Role of specialized pro-resolving lipid mediators in pulmonary inflammation diseases: mechanisms and development. Respiratory Research. 2021;22(1):204.  https://doi.org/10.1186/s12931-021-01792-y
  53. Serhan CN, Dalli J, Colas RA, Winkler JW, Chiang N. Protectins and maresins: New pro-resolving families of mediators in acute inflammation and resolution bioactive metabolome. Biochimica Biophysica Acta. 2015;1851(4):397-413.  https://doi.org/10.1016/j.bbalip.2014.08.006
  54. Molfino A, Amabile MI, Monti M, Muscaritoli M. Omega-3 Polyunsaturated Fatty Acids in Critical Illness: Anti-Inflammatory, Proresolving, or Both? Oxidative Medicine and Cellular Longevity. 2017;2017:5987082. https://doi.org/10.1155/2017/5987082
  55. Kumar V, Fausto N, Abbas AK. Robbins and Cotran Pathologic Basis of Disease. 8-th ed. Elsevier/Saunders; 2010.
  56. Julliard WA, Myo YPA, Perelas A. Specialized pro-resolving mediators as modulators of immune responses. Seminars in Immunology. 2022;59:101605. https://doi.org/10.1016/j.smim.2022.101605
  57. Serhan CN, Levy BD. Resolvins in inflammation: emergence of the pro-resolving superfamily of mediators. The Journal of Clinical Investigation. 2018;128(7):2657-2669. https://doi.org/10.1172/JCI97943
  58. Ferreira I, Falcato F, Bandarra N, Rauter AP. Resolvins, Protectins, and Maresins: DHA-Derived Specialized Pro-Resolving Mediators, Biosynthetic Pathways, Synthetic Approaches, and Their Role in Inflammation. Molecules. 2022;27(5):1677. https://doi.org/10.3390/molecules27051677
  59. Chiang N, Serhan CN. Specialized pro-resolving mediator network: an update on production and actions. Essays in Biochemistry. 2020;64(3):443-462.  https://doi.org/10.1042/EBC20200018
  60. Jordan PM, Werz O. Specialized pro-resolving mediators: biosynthesis and biological role in bacterial infections. FEBS Journal. 2022;289(14):4212-4227. https://doi.org/10.1111/febs.16266
  61. Shimizu T, Saito T, Aoki-Saito H, Okada S, Ikeda H, Nakakura T, Fukuda H, Arai S, Fujiwara K, Nakajima Y, Horiguchi K, Yamada S, Ishida E, Hisada T, Shuto S, Yamada M. Resolvin E3 ameliorates high-fat diet-induced insulin resistance via the phosphatidylinositol-3-kinase/Akt signaling pathway in adipocytes. FASEB Journal. 2022;36(3):e22188. https://doi.org/10.1096/fj.202100053R
  62. Jiang JH, Hassan KA, Begg SL, Rupasinghe TWT, Naidu V, Pederick VG, Khorvash M, Whittall JJ, Paton JC, Paulsen IT, McDevitt CA, Peleg AY, Eijkelkamp BA. Identification of Novel Acinetobacter baumannii Host Fatty Acid Stress Adaptation Strategies. mBio. 2019;10(1):e02056-18.  https://doi.org/10.1128/mBio.02056-18
  63. Zang M, Adams FG, Hassan KA, Eijkelkamp BA. The Impact of Omega-3 Fatty Acids on the Evolution of Acinetobacter baumannii Drug Resistance. Microbiology Spectrum. 2021;9(3):e0145521. https://doi.org/10.1128/Spectrum.01455-21
  64. Gallo CG, Fiorino S, Posabella G, Antonacci D, Tropeano A, Pausini E, Pausini C, Guarniero T, Hong W, Giampieri E, Corazza I, Loiacono R, Loggi E, de Biase D, Zippi M, Lari F, Zancanaro M. The function of specialized pro-resolving endogenous lipid mediators, vitamins, and other micronutrients in the control of the inflammatory processes: Possible role in patients with SARS-CoV-2 related infection. Prostaglandins and other Lipid Mediators. 2022;159:106619. https://doi.org/10.1016/j.prostaglandins.2022.106619
  65. Yasmeen N, Selvaraj H, Lakhawat SS, Datta M, Sharma PK, Jain A, Khanna R, Srinivasan J, Kumar V. Possibility of averting cytokine storm in SARS-COV 2  patients using specialized pro-resolving lipid mediators. Biochemical Pharmacology. 2023;209:115437. https://doi.org/10.1016/j.bcp.2023.115437
  66. Calder PC. Eicosapentaenoic and docosahexaenoic acid derived specialised pro-resolving mediators: Concentrations in humans and the effects of age, sex, disease and increased omega-3 fatty acid intake. Biochimie. 2020;178:105-123.  https://doi.org/10.1016/j.biochi.2020.08.015
  67. Pradelli L, Mayer K, Klek S, Omar Alsaleh AJ, Clark RAC, Rosenthal MD, Heller AR, Muscaritoli M. ω-3 Fatty-Acid Enriched Parenteral Nutrition in Hospitalized Patients: Systematic Review With Meta-Analysis and Trial Sequential Analysis. Journal of Parenteral and Enteral Nutrition. 2020;44(1):44-57.  https://doi.org/10.1002/jpen.1672
  68. Pradelli L, Klek S, Mayer K, Omar Alsaleh AJ, Rosenthal MD, Heller AR, Muscaritoli M. Omega-3 fatty acid-containing parenteral nutrition in ICU patients: systematic review with meta-analysis and cost-effectiveness analysis. Critical Care. 2020;24(1):634.  https://doi.org/10.1186/s13054-020-03356-w
  69. Wang C, Han D, Feng X, Wu J. Omega-3 fatty acid supplementation is associated with favorable outcomes in patients with sepsis: an updated meta-analysis. Journal of International Medical Research. 2020;48(12):300060520953684. https://doi.org/10.1177/0300060520953684
  70. Wang H, Su S, Wang C, Hu J, Dan W, Peng X. Effects of fish oil-containing nutrition supplementation in adult sepsis patients: A systematic review and meta-analysis. Burns and Trauma. 2022;10:tkac012. https://doi.org/10.1093/burnst/tkac012
  71. Zhu D, Zhang Y, Li S, Gan L, Feng H, Nie W. Enteral omega-3 fatty acid supplementation in adult patients with acute respiratory distress syndrome: a systematic review of randomized controlled trials with meta-analysis and trial sequential analysis. Intensive Care Medicine. 2014;40(4):504-512.  https://doi.org/10.1007/s00134-014-3244-5
  72. Langlois PL, D’Aragon F, Hardy G, Manzanares W. Omega-3 polyunsaturated fatty acids in critically ill patients with acute respiratory distress syndrome: A systematic review and meta-analysis. Nutrition. 2019;61:84-92.  https://doi.org/10.1016/j.nut.2018.10.026
  73. Huang Z, Zheng J, Huang W, Yan M, Hong L, Hong Y, Jin R, Huang X, Fan H, Chen H, Yang H, Su W, Huang X. The effects and safety of omega-3 fatty for acute lung injury: a systematic review and meta-analysis. World Journal of Surgical Oncology. 2020;18(1):235.  https://doi.org/10.1186/s12957-020-01916-6
  74. Koekkoek WK, Panteleon V, van Zanten AR. Current evidence on ω-3 fatty acids in enteral nutrition in the critically ill: A systematic review and meta-analysis. Nutrition. 2019;59:56-68.  https://doi.org/10.1016/j.nut.2018.07.013
  75. Naghibi T, Shafigh N, Mazloomzadeh S. Role of omega-3 fatty acids in the prevention of delirium in mechanically ventilated patients. Journal of Research in Medical Sciences. 2020;25:10.  https://doi.org/10.4103/jrms.JRMS_567_18
  76. Doaei S, Gholami S, Rastgoo S, Gholamalizadeh M, Bourbour F, Bagheri SE, Samipoor F, Akbari ME, Shadnoush M, Ghorat F, Mosavi Jarrahi SA, Ashouri Mirsadeghi N, Hajipour A, Joola P, Moslem A, Goodarzi MO. The effect of omega-3 fatty acid supplementation on clinical and biochemical parameters of critically ill patients with COVID-19: A randomized clinical trial. Journal of Translational Medicine. 2021;19(1):128.  https://doi.org/10.1186/s12967-021-02795-5
  77. Wu S-C, Chen T-A, Tsai I-J, Wang Y-C, Cheng H-T, Tzeng C-W, Hsu C-H, Muo C-H. Lipid-Free Parenteral Nutrition Is Associated with an Increased Risk of Hepatic Dysfunction in Surgical Critically Ill Patients: A Retrospective Observational Study. Healthcare. 2021;9(9):1096. https://doi.org/10.3390/healthcare9091096

Email Confirmation

An email was sent to test@gmail.com with a confirmation link. Follow the link from the letter to complete the registration on the site.

Email Confirmation

We use cооkies to improve the performance of the site. By staying on our site, you agree to the terms of use of cооkies. To view our Privacy and Cookie Policy, please. click here.