Die metabolische Selbstzerstörung des kritisch kranken Patienten (Teil II): Die Bedeutung der modernen Medizin und therapeutische Konsequenzen^{[1] [2]}

Zusammenfassung

Die moderne Medizin (Intensiv- und Notfallmedizin) ermöglicht das akute Überleben eines Patienten auch nach sehr schwerer Homöostasestörung. Dieser Fortschritt hat jedoch die Nützlichkeit von prinzipiell vorteilhaften, adaptativen metabolischen Reaktionen (Hyperglykämie, Muskeleiweißkatabolismus) dahingehend modifiziert, dass diese nun in übersteigertem Ausmaß ausgelöst werden und dadurch selbstzerstörerische Wirkungen entfalten können. Potenziell schädliche Nebenwirkungen der metabolischen Reaktionen resultieren aus deren Quantität, welche durch Intensität und Dauer der Homöostasestörung bestimmt wird. Adjuvante Therapien wie die künstliche Ernährung können metabolischen Extremreaktionen auf keinen Fall verhindern, sondern allerhöchstens helfen, sekundären Schaden zu minimieren. Eine effektive metabolische Therapie ist nur dann möglich, wenn gleichzeitig die Auslösemechanismen (Trauma, Shock, Sepsis) so aggressiv wie möglich bekämpft werden, um dadurch die metabolischen Triggermechanismen bereits an ihrem Ursprung zu unterbrechen.

Abstract

Modern emergency and intensive care medicine allows patients to survive even extreme disturbances of their homeostasis. This progress, however, has modified utility of originally advantageous metabolic reactions (hyperglycemia, muscle protein catabolism) to a point where their activation is exaggerated thereby revealing auto-destructive elements. Potentially detrimental side effects of metabolic reactions result from their quantity which is determined by extent and duration of the disturbance of homeostasis. Self-destructive metabolic responses cannot be prevented by adjuvant therapies such as artificial nutrition which may only help to ameliorate secondary metabolic damage. Effective treatment is only possible by a simultaneous aggressive therapy of underlying pathologies (such as shock, trauma or infection) thereby interrupting secondary metabolic trigger mechanisms at an early stage.

Schlüsselwörter

schwere Sepsis - Trauma - Schock - Fokus-Eradikation - Hyperglykämie - Eiweißkatabolismus - künstliche Ernährung - intestinales Mikrobiom

Keywords

severe sepsis - trauma - shock - focus eradication - hyperglycemia - protein catabolism - artificial nutrition - gut microbiome

¹ Im Original publiziert unter: Hartl WH, Jauch KW. Metabolic self-destruction in critically ill patients: Origins, mechanisms and therapeutic principles. Nutrition 2014 Mar; 30 (3): 261 – 267

² Nachdruck aus: DIVI Journal 2015; 6: 102 – 107

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