Zusammenfassung
Der prognostische Einfluss einer adäquaten Energie-
und Proteinzufuhr ist gerade für den mangelernährten
Intensivpatienten aktuell erneut gezeigt worden. Konsens besteht über
die Vorteile einer frühzeitigen enteralen Ernährung.
Das Bestehen einer gastrointestinalen Intoleranz schafft beim kritisch
Kranken häufig jedoch erhebliche Probleme und auch Risiken
bei der Durchführung. Für den Fall einer unzureichenden
enteralen Kalorienzufuhr wird die Zeitspanne bis zum Beginn einer
totalen oder kombiniert enteralen und parenteralen Ernährung
kontrovers diskutiert. Da beim kritischen Kranken ungünstige
Effekte nicht ausgeschlossen werden können, muss die Gabe von
immunomodulierenden Substraten besonders vorsichtig erfolgen. Empfohlen
wird die Implementierung eines leitlinienbasierten Ernährungsprotokolls.
Hierbei bezieht die vorliegende Übersicht die aktuellen
Leitlinien der Europäischen Gesellschaft für klinische
Ernährung und Metabolismus (ESPEN) von 2009, der Amerikanischen
Gesellschaft für Parenterale und Enterale Ernährung
(ASPEN) von 2009 und der Deutschen Sepsis-Gesellschaft (DSG) von
2010 ein.
Abstract
The prognostic impact of inadequate energy and protein supply
in malnourished intensive care patients has been recently reemphasized.
Consent exists about the beneficial effects of early enteral nutrition
in the critically ill. However, gastrointestinal intolerance of
the critically ill may be a major problem for the feasibility of
enteral nutrition bearing additional risks. In case adequate enteral
nutrition cannot be realized, there is controversy about the appropriate
time to start total parenteral or combined enteral / parenteral
nutrition. Due to potential adverse effects immune-enhancing substrates
have to be cautiously administered. For standardization implementation
of a guideline based nutritional protocol is recommended. The review
refers to the recent guidelines of the European Society for Clinical
Nutrition and Metabolism (2009), the American Society for Parenteral
and Enteral Nutrition (ASPEN) (2009) and the German Sepsis Society
(DSG) (2010).
Schlüsselwörter
Enterale Ernährung - parenterale Ernährung - metabolisches Risiko
Keywords
nutritional support - enteral nutrition - parenteral nutrition - nutritional risk
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Prof. Dr. A. Weimann M.A.
Klinik für Allgemein- und Visceralchirurgie
Klinikum
St. Georg gGmbH
Delitzscher Str. 141
04129 Leipzig
Phone: 0341/909-2200
Fax: 0341/909-2234
Email: Arved.Weimann@sanktgeorg.de
