Ernährungskonzepte bei Intensivpatienten

Zusammenfassung

Das klinische Outcome von Intensivpatienten kann durch eine standardisierte Ernährungstherapie verbessert werden. Allerdings sind Studien zur enteralen oder parenteralen Ernährung, die den Anforderungen der „evidence-based medicine” gerecht werden, noch rar. Aus diesem Grund muss die Standardisierung immer noch ganz wesentlich auf dem Boden pathophysiologischer Überlegungen erfolgen. Wir beschreiben ein Konzept zur enteralen und parenteralen Ernährung schwer kranker Patienten, das eine Hyperalimentation in der akuten Phase der Erkrankung vermeidet und gleichzeitig immunologische Gesichtspunkte bei der Substratauswahl berücksichtigt. Eine äquivalente Zusammensetzung von enteraler und parenteraler Ernährung ermöglicht den problemlosen Übergang zwischen beiden Ernährungsformen. Das Ernährungsziel ergibt sich aus der Multiplikation der Grundrate, d. h. dem Körpergewicht in KG als Laufrate in ml/h - entsprechend 24 kcal/kg KG/24 h - mit dem Zielfaktor, der zwischen 0,2 und 1,8 liegt. Die enterale und parenterale Ernährung wird begleitet von der Zufuhr immunmodulierender Substanzen, d. h. von Glutamin und Antioxidantien.

Abstract

The clinical outcome of critical ill patients can be improved by standardised nutrition. However, trials meeting the standard of evidence-based medicine are rare. For this reason, standards still have to be based on pathophysiological considerations. We describe a concept of combined nutrition for critically ill patients which avoids hyperalimentation and considers also immunological aspects. An equivalent composition of enteral and parenteral nutrition allows a transition between both forms without problems. The nutritional goal is defined by multiplication of the base rate, i. e., body weight in kg as delivery rate in mL/h, - corresponding to 24 kcal/kg BW/24 h - with a target factor which varies between 0.2 and 1.8. Both forms of nutrition are complemented by immune-modulating substrates as glutamine and antioxidants.

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1 Das hier beschriebene Konzept wurde in Zusammenarbeit mit der Firma Fresenius Kabi Deutschland GmbH entwickelt.