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Aktuelle Ernährungsmedizin 2012; 37(1): 36-57
DOI: 10.1055/s-0031-1277004
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© Georg Thieme Verlag KG Stuttgart · New York

Ernährung von Intensivpatienten

Nutrition of the Critically IllT.  W.  Felbinger1 , H.  P.  Richter1
  • 1Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Klinikum Neuperlach, Städtisches Klinikum München GmbH
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Publication History

Publication Date:
14 February 2012 (online)

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Zusammenfassung

Mangelernährung ist ein häufiges und outcomerelevantes Problem auf der Intensivstation. Bei kritisch Kranken verschlechtert sich der Ernährungszustand bei vielen Patienten als Konsequenz des Stressstoffwechsels und einer inadäquaten Substratzufuhr weiter. Die klinische, an den Stoffwechsel des kritisch Kranken adaptierte Ernährung ist die einzige spezifische Therapie einer manifesten oder drohenden Mangelernährung. Dabei muss der Fokus darauf liegen, eine Hyperalimentation in der Frühphase und eine Hypoalimentation in der prolongierten Phase des Intensivaufenthalts zu vermeiden. Zusätzlich werden Omega-3-Fettsäuren und Antioxidanzien auf enteralem Weg bei ARDS (Adult Respiratory Distress Syndrome) empfohlen. Bei Indikation zu einer parenteralen Ernährung soll parenterales Glutamin hoch dosiert verabreicht werden.

Abstract

Malnutrition occurs frequently in the ICU influencing clinical outcome in critically ill patients. As a consequence of stress metabolism and inadequate intake, nutritional status deteriorates in most critically ill patients during their ICU stay. Artificial nutritional support is the only specific therapy to overcome the metabolic consequences of malnutrition. In critically ill patients priority must be given to avoid hyperalimentation in the early phase and hypoalimentation in the prolonged phase of an ICU stay. In ARDS patients, supplementation of enteral diet enriched with omega-3-fatty acids and antioxidants improved outcome. Whenever parenteral nutrition is indicated, high dose parenteral glutamine supplementation should be applied.

Schlüsselwörter

Ernährung - enteral - parenteral - Immunmodulation

Keywords

nutrition - enteral - parenteral - immunomodulation

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Priv.-Doz. Dr. med. Thomas W. Felbinger

Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Klinikum Neuperlach, Städtisches Klinikum München GmbH

Oskar-Maria-Graf-Ring 51

81377 München

Email: thomas.felbinger@klinikum-muenchen.de