S3-Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) in Zusammenarbeit mit der GESKES, der AKE, der DGCH^[a], der DGAI^[b] und der DGAV^[c]

Zusammenfassung

Fragestellung: Enhanced recovery after surgery (ERAS) Programme sind der Standard im perioperativen Management. Berücksichtigt werden muss der nachgewiesene Einfluss einer krankheitsassoziierten Mangelernährung auf die postoperative Morbidität und Letalität. So bedürfen Patienten mit metabolischem Risiko oder manifester Mangelernährung sowie solche Patienten mit postoperativen Komplikationen besonderer ernährungsmedizinischer Aufmerksamkeit.

Methodik: Die bestehenden Leitlinien der deutschen und europäischen ernährungsmedizinischen Fachgesellschaften (DGEM, ESPEN) zur enteralen und parenteralen Ernährung wurden zusammengeführt und in Einklang mit den prozeduralen Vorgaben der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF) und des Ärztlichen Zentrums für Qualität in der Medizin (ÄZQ) aktualisiert und erweitert.

Ergebnisse: Von der Arbeitsgruppe wurden 41 in der Leitlinienkonferenz konsentierte Empfehlungen zur perioperativen Ernährung mit folgender Empfehlungsstärke erarbeitet: 9-mal A (Empfehlung basiert auf schlüssiger Literatur guter Qualität, die mind. eine randomisierte Studie enthält), 12-mal B (Empfehlung basiert auf gut durchgeführten, nicht randomisierten Studien), 13-mal C (Empfehlung basiert auf Berichten und Meinungen von Expertenkreisen und/oder klinischen Erfahrungen anerkannter Autoritäten) und 7-mal KKP (klinischer Konsenspunkt).

Schlussfolgerung: Eine perioperative supplementierende künstliche Ernährung ist auch bei Patienten ohne offensichtliche Mangelernährung indiziert, sofern vorhersehbar ist, dass der Patient für eine längere postoperative Zeitdauer unfähig zur adäquaten oralen Kalorienzufuhr sein wird.

Abstract

Purpose: While enhanced recovery after surgery (ERAS) programmes are the standard of perioperative management special nutritional care has to be attributed to malnourished patients and those at metabolic risk with special regard to those with complications.

Methods: Existing guidelines of the German and European societies of nutritional medicine (DGEM, ESPEN) on enteral and parenteral nutrition in surgery were merged and in accordance with the principles of the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF; German Association of the Scientific Medical Societies) and Ärztliches Zentrum für Qualität in der Medizin (AeZQ; German Agency for Quality in Medicine) revised and extended.

Results: The working group developed 41 consensus-based recommendations for perioperative nutrition. The recommendation strength is: 9x A (recommendation based on significant literature of good quality, at least one randomized controlled trial), 12x B (recommendation based on well-designed trial without randomization), 13x C (recommendation based on expert opinions and/or clinical experience of respected authorities) und 7x CCP (clinical consensus point).

Conclusion: Even in patients without obvious malnutrition perioperative nutritional support is indicated when oral food intake is not feasible or inadequate for a longer period of time.

Schlüsselwörter

Leitlinie - perioperative Ernährung - enteral - parenteral - Sondenernährung - Feinnadelkatheterjejunostomie - Immunonutrition

Keywords

guideline - perioperative nutrition - nutritional support - enteral - parenteral - tube feeding - fine needle catheter jejunostomy - immunonutrition

^a DGCH e. V. = Deutsche Gesellschaft für Chirurgie e. V.

^b DGAI e. V. = Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e. V.

^c DGAV e. V. = Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie e. V.

^* DGEM Steering Committee: Bischoff SC, Lochs H, Weimann A sowie das DGEM-Präsidium

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