Ernährung in der internistischen Intensivmedizin

Zusammenfassung

Ziel der Ernährungstherapie kritisch kranker Patienten in der Intensivmedizin ist, die negativen Effekte einer Mangelernährung zu minimieren, die Körperhomöostase aufrecht zu erhalten und die Grunderkrankung positiv zu beeinflussen. In der Akutphase der Therapie von Intensivpatienten überwiegen katabole Stoffwechselprozesse, nach der Stabilisierung des Patienten steht die Proteinanabolie im Vordergrund. Die enterale Ernährung über nasogastrale Sonden nimmt eine Schlüsselstellung in der Ernährungstherapie kritisch kranker Patienten ein. Hochmolekulare Ernährunglösungen sind Standard in der internistischen intensivmedizinischen Ernährungstherapie. Kann eine ausreichende enterale Ernährung nicht gewährleistet werden, ist eine Kombination aus enteraler und parenteraler Ernährung sinnvoll. Die Möglichkeit der Durchführung einer zumindest minimalen enteralen Ernährung ist immer zu bedenken. Eine Evaluation des aktuellen Ernährungsstatus des Patienten bei Aufnahme auf die Intensivstation ist notwendig, um die Ernährungstherapie den individuellen Bedürfnissen und der Grunderkrankung anzupassen. Über- und Unterernährung haben einen negativen Einfluss auf das Outcome von Intensivpatienten.

Summary

It is the intent of intensive care to minimise negative effects of malnutrition, to maintain body homoeostasis and to positively influence primary diseases. Whereas catabolic metabolic processes are usually met in the initial phase, effects of protein anabolism often occur in the phase of stabilisation. Enteral nutrition using a nasogastral tube is a proven method of treating critically ill patients. Administration of highly molecular nutritional solutions is a frequently used dietotherapy in internistic intensive care units. If an adequate enteral nutrition cannot be realised, a combination of enteral and parenteral nutrition may be appropriate. Even an at least minimal enteral nutrition should always be considered. A correct evaluation of the patient’s actual nutritional state is a must when he is received in an intensive care unit so as to adapt dietotherapeutic regimes to actual requirements of the primary disease. Over- and undernutrition have a detrimental effect on the outcome of the therapy in the intensive care unit.

Schlüsselwörter

enterale/parenterale Ernährung - minimale enterale Ernährung - Mangelernährung - Sepsis - akutes Nierenversagen - ARDS

Key words

Enteral - parenteral nutrition - minimal enteral nutrition - malnutrition - sepsis - acute renal failure - adult respiratory distress syndrome ARDS

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