Zusammenfassung
Die Ernährung von Intensivpatienten ist aufgrund der komplexen metabolischen Veränderungen eine große Herausforderung. Vor diesem Hintergrund stellt eine stoffwechseladaptierte Ernährung die einzige Möglichkeit zur Vermeidung von Hyper- oder Hypoalimentation dar und hat dadurch direkten Einfluss auf die Prognose. Neben der Analyse des Energiebedarfs ist die Wahl des Applikationswegs von entscheidender Bedeutung. Eine frühzeitige enterale Ernährung ist anzustreben. Hierbei werden in der Praxis oftmals auch supplementierende parenterale Regime benötigt, um eine ausreichende Kalorienzufuhr sicherzustellen. Die meisten heute verfügbaren Standardernährungslösungen sind in ihrer Nährstoffzusammensetzung optimiert – ein regelmäßiges metabolisches und gastrointestinales Monitoring wird trotzdem empfohlen. Bei ausgesuchten Patientengruppen kann die Verabreichung immunmodulierender Substanzen indiziert sein – von einem unkritischen Einsatz muss wegen oftmals unzureichender oder widersprüchlicher Studienlage abgeraten werden.
Abstract
Nutrition of intensive care patients is challenging due to complex metabolic changes. For this reason nutritional support adapted to the metabolic state is the only effective option to avoid hyperalimentation or hypoalimentation and thus has a direct influence on the prognosis. The analysis of the calorific requirement and the mode of administration are of key importance. An early enteral nutrition should be established, whereas in practice often a supplementary parenteral support is required to provide adequate calorie supply. Nowadays, most commercially available standard solutions are optimized concerning composition of nutrients; however, metabolic and gastrointestinal monitoring is recommended. In a selected group of patients the administration of immunomodulatory substances may be indicated but due to insufficient or conflicting study data an uncritical use of these supplements cannot be recommended.
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Interessenkonflikt
Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: Dr. K. Mayer erhielt in den letzten 3 Jahren Honorare für produktneutrale Vorträge von Abbot, Baxter, B. Braun, Fresenius Kabi und Nestle. Dr. T. Felbinger erhielt in den letzten 3 Jahren Honorare für produktneutrale Vorträge von Abbot, Baxter, B. Braun, Fresenius Kabi und Nutrica.
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Hecker, M., Felbinger, T. & Mayer, K. Ernährung in der Intensivmedizin. Anaesthesist 61, 553–564 (2012). https://doi.org/10.1007/s00101-012-2034-0
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DOI: https://doi.org/10.1007/s00101-012-2034-0