Der mangelernährte Patient auf der Intensivstation

Bis zu 30% aller Krankenhauspatienten weisen einen Zustand der Mangelernährung auf, der Anteil der Intensivpatienten ist noch deutlich höher. Wenn man nun bedenkt, dass Unterernährung bei Krankenhauspatienten mit einem schlechteren Outcome verbunden ist als Normalgewichtigkeit, ist die Relevanz der Erfassung von eventuellen Mangelzuständen und deren möglichst umgehende Behebung offensichtlich.

Kernaussagen

• Mangelernährte Patienten finden sich auf der Intensivstation häufiger, als allgemein bekannt ist.

• Mangelernährte Intensivpatienten haben eine höhere Intensivletalität als normal- oder geringgradig übergewichtige Intensivpatienten.

• Ausgeprägte klinische Bilder einer Mangelernährung finden sich u. a. bei Patienten mit einer Tumorkachexie und bei Patienten mit einer Anorexia nervosa.

• Wenn möglich sollten mangelernährte Patienten vor elektiven großen operativen oder interventionellen Eingriffen schon eine spezielle Ernährungstherapie erhalten.

• Bei mangelernährten Patienten sollten die angestrebten täglichen Kalorien- und Proteinmengen innerhalb von 24 – 48 Stunden zu 80% und innerhalb von 7 Tagen zu 100% erreicht werden.

• Zu Beginn einer Ernährungstherapie von mangelernährten Patienten muss auf das Auftreten eines Refeeding-Syndroms geachtet werden.

Schlüsselwörter

Anorexia nervosa - Untergewicht - Malnutrition - Tumorkachexie - Refeeding-Syndrom

• Literatur

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