S3-Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) in Zusammenarbeit mit der GESKES und der AKE

Zusammenfassung

Fragestellung: Unter künstlicher Ernährung können bestimmte Komplikationen auftreten. Um deren Häufigkeit zu minimieren, sind spezifische Überwachungsmaßnahmen erforderlich. Ziel der vorliegenden Leitlinie ist es, diesbezüglich evidenzbasierte Empfehlungen zu geben.

Methodik: Die bestehende Leitlinie der deutschen ernährungsmedizinischen Fachgesellschaft (DGEM) wurde in Einklang mit den Richtlinien der AWMF und des ÄZQ aktualisiert und erweitert.

Ergebnisse: Die Leitlinie beinhaltet 13 konsentierte Empfehlungen zur spezifischen Überwachung von Patienten, die künstlich ernährt werden. Speziell eingegangen wird auf Probleme bei der Menge der zugeführten Substrate, auf klinische Dysfunktionen des oberen und unteren Gastrointestinaltrakts (einschließlich eines erhöhten gastralen Residualvolumens, GRV) und auf Glukose- und Fettverwertungsstörungen. Generell sollte die Menge der tatsächlich zugeführten Substrate/Flüssigkeiten engmaschig überwacht und dokumentiert werden. Unter enteraler Ernährung ist speziell bei kritisch kranken Patienten in der Akutphase eine klinische Überwachung der gastrointestinalen Funktionen (Abdominalbefund, Darmtätigkeit) unerlässlich, die bei chirurgischen Patienten auch die Messung des GRV miteinbeziehen sollte. Speziell bei Diabetikern bzw. im Rahmen eines Postaggressionssyndroms ist ferner eine regelmäßige Messung der Glukose- und Triglyzeridkonzentration erforderlich, wobei bestimmte Grenzwerte (400 mg/dL [4,6 mmol/L] bzw. 200 mg/dL [11,0 mmol/L]) nicht überschritten werden sollten.

Schlussfolgerung: Überwachungsmaßnahmen sind unerlässlicher Bestandteil der künstlichen Ernährung. Inhalt und Intensität hängen von der Modalität und von der Art bzw. vom Stadium der Grunderkrankung ab. Spezifische Grenzwerte/Toleranzschwellen sind zu beachten.

Abstract

Purpose: Artificial nutrition may be associated with specific complications. To minimize their frequency, surveillance measures are indispensable. Based on sound scientific evidence the new guideline wants to present corresponding recommendations.

Methods: In accordance with the principles of the AWMF and the AEZQ, the existing guideline of the German Society of Nutritional Medicine was revised and updated.

Results: The guideline presents 13 consensus-based recommendations concerning the specific surveillance of patients requiring artificial nutrition. We closely address problems related to the adequacy of nutritional support, malfunction of the upper and lower gastrointestinal tract (including an increased gastric residual volume, GRV), and glucose and fat malassimilation. Generally the amount of substrates actually consumed by or delivered to the patient should closely be monitored and documented. In critically ill patients fed enterally, clinical monitoring of gastrointestinal functions (abdominal findings, bowel movements etc.) is indispensable and should be intensified during the acute phase. Surgical patients may profit from an additional measurement of GRV. Diabetic patients and patients during the acute phase of a disease additionally require regular measurements of triglyceride and glucose concentrations. For those parameters it is recommended to respect specific upper limits (400 mg/dL [4.6 mmol/L] and 200 mg/dL [11.0 mmol/L], respectively).

Conclusion: Surveillance measures are an integral part of artificial nutrition. Way and intensity of surveillance measures are guided by the modality of artificial nutrition, and by the type and stage of the underlying disease. Specific upper limits/threshold concentrations should be respected.

Schlüsselwörter

künstliche Ernährung - enterale Ernährung - Gastrointestinaltrakt - Substratzufuhr - gastrales Residualvolumen - Triglyzeridkonzentration - Glukosekonzentration - Diabetes

Keywords

artificial nutrition - enteral nutrition - gastrointestinal tract - substrate supply - gastric residual volume - triglyceride concentration - glucose concentration

^* DGEM Steering Committee: Bischoff SC, Lochs H, Weimann A, Adolph M, Ockenga J, Sieber C

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