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Ernährung in der Intensivmedizin

Teil 2: spezielle Ernährungsprobleme
  • M. Hecker
  • T.W. Felbinge
  • K. Mayer

Zusammenfassung

Die Therapie von Intensivpatienten wird oftmals durch Begleiterkrankungen oder komplexe Systemerkankungen wie Sepsis kompliziert. Die Notwendigkeit, für jeden Intensivpatienten ein individualisiertes Ernährungskonzept zu erstellen, gewinnt in den letzten Jahren zunehmend an Bedeutung, da diese wichtige support ive Maßnahme direkten Einfluss auf das Outcome des Patienten hat. Im vorliegenden Beitrag liegt ein besonderer Schwerpunkt auf den speziellen ernährungsmedizinischen Fragestellungen von Intensivpatienten. Die aktuellen Empfehlungen und Studien zu intensivmedizinisch relevanten Krankheitsbildern wie akutem sowie chronischem Nieren- und Leberversagen, akutem Lungenversagen und Sepsis werden präsentiert und diskutiert. Einen weiteren Fokus stellt die Etablierung eines geeigneten Ernährungsregimes für Patienten nach großen Operationen oder Polytrauma dar.

Schlüsselwörter

Nierenversagen Leberversagen Sepsi "Acute respiratory distress syndrome" Operationen 

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Literature

  1. 1.
    Hecker M, FelbingerT, Mayer K (2012) Ernährung in der Intensivmedizin. Anaesthesist 61:553–564PubMedGoogle Scholar
  2. 2.
    Fiaccadori E, Maggiore U, Rotelli C et al (2005) Effects of different energy intakes on nitrogen balance in patients with acute renal failure: a pi­lot study. Nephral DialTransplant 20:1976–1980Google Scholar
  3. 3.
    Cano N, Fiaccadori E, Tesinsky P et al (2006) ESPEN guidelines on enteral nutrition: adult renal failure. Clin Nutr 25:295–310PubMedGoogle Scholar
  4. 4.
    MirtalloJM, Schneider PJ, MavkoK etal (1982) Acomparison of essential and general amino acid infusions in the nutritional support of patients with compromised renal function. JPEN J Parenter Enterai Nutr 6:109–113Google Scholar
  5. 5.
    Smolle KH, Kaufmann P, Fleck S et al (1997) Influenceof a novel amino acid Solution (enriched with the dipeptide glycyl-tyrosine) on plasma amino acid concentration of patients with acute renal failure. Clin Nutr 16:239–246PubMedGoogle Scholar
  6. 6.
    Patek AJ, Post J (1941) Treatment of cirrhosis of the liver by a nutritious diet and supplements rieh in Vitamin Bcomplex.JClin Invest 20:481–505Google Scholar
  7. 7.
    Müller MJ, Lautz HU, Plogmann B et al (1992) Energy expenditure and substrate oxidation in patients with cirrhosis: the impact of cause, clinical Staging and nutritional State. Hepatology 15:782–794Google Scholar
  8. 8.
    KondrupJ, Muller MJ (1997) Energy and protein requirements of patients with chronic liver disease. J Hepatol 27:239–247Google Scholar
  9. 9.
    Ais-Nielsen B, Koretz RL, Kjaergard LL, Gluud C (2003) Branched-chain amino acids for hepatic eneephalopathy. Cochrane Database Syst Rev:CD001939Google Scholar
  10. 10.
    Naylor CD, O’Rourke K, Detsky AS, Baker JP (1989) Parenteral nutrition with branched-chain amino acids in hepatic eneephalopathy. A metaanalysis. Gastroenterology 97:1033–1042PubMedGoogle Scholar
  11. 11.
    Hecker M, WeigandMA, Mayer K (2012) Akute respiratorische Insuffizienz. Internist 53:557–566PubMedGoogle Scholar
  12. 12.
    MayerK, KiesslingA, OttJetal (2009) Acute lung injury is reduced in fat-1 mice endogenously synthesizing n-3 fatty acids. Am J Respir Crit CareMed 179:474–483Google Scholar
  13. 13.
    Gadek JE, DeMichele SJ, Karlstad MD etal (1999) Effectofenteralfeeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in patients with acute respiratory distress Syndrome. Enterai Nutrition in ARDS Study Group. Crit Care Med 27:1409–1420PubMedGoogle Scholar
  14. 14.
    Marik PE, Zaloga GP (2008) Immunonutrition in critically ill patients: a systematic review and analysis of the literature. Intensive Care Med 34:1980–1990PubMedGoogle Scholar
  15. 15.
    Kreymann KG, Berger MM, Deutz NE et al (2006) ESPEN guidelines on enteral nutrition: intensive care. Clin Nutr 25:210–223PubMedGoogle Scholar
  16. 16.
    Rice TW, Wheeler AP, Thompson BT et al (2011) Enterai omega-3 fatty acid, gamma-linolenic acid, and antioxidant supplementation in acute lung injury. JAMA 306:1574–1581PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    FelbingerTW, Weigand MA, Mayer K (2012) Supplementation in acute lung injury. JAMA 307:144Google Scholar
  18. 18.
    Singer P, Berger MM, Van den Berghe G et al (2009) ESPEN guidelines on parenteral nutrition: intensive care. Clin Nutr 28:387–400PubMedGoogle Scholar
  19. 19.
    Suchner U, Katz DP, Fürst P et al (2001) Effects of intravenous fat emulsions on lung function in patients with acute respiratory distress Syndrome or sepsis. Crit Care Med 29:1569–1574PubMedGoogle Scholar
  20. 20.
    Wiedemann HP, Wheeler AP, Bernard GR et al (2006) Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 354:2564–2575PubMedGoogle Scholar
  21. 21.
    Burke JF, Wolfe RR, Mullany CJ et al (1979) Glucose requirements following burn injury. Parameters of optimal glucose infusion and possible hepatic and respiratory abnormalities following excessive glucose intake. Ann Surg 190:274–285PubMedPubMedCentralGoogle Scholar
  22. 22.
    Casaer MP, Mesotten D, Hermans G et al (2011) Early versus late parenteral nutrition in critically ill adults. N Engl J Med 365:506–517PubMedGoogle Scholar
  23. 23.
    Villet S, Chiolero RL, Bollmann MD et al (2005) Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. Clin Nutr 24:502–509PubMedGoogle Scholar
  24. 24.
    van den Berghe G, Wouters P, Weekers Fetal (2001) Intensiveinsulin therapy in critically ill patients. N Engl J Med 345:1359–1367Google Scholar
  25. 25.
    Brunkhorst FM, Engel C, Bloos F, Meier-Hellmann A et al (2008) Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 358:125–139PubMedGoogle Scholar
  26. 26.
    Finfer S, Chittock DR, Su SY et al (2009) Intensive versus conventional glucose control in critically ill patients. N Engl J Med 360:1283–1297PubMedGoogle Scholar
  27. 27.
    Bertolini G, lapichino G, Radrizzani D et al (2003) Early enteral immunonutrition in patients with severe sepsis: results of an interim analysis of a randomized multicentre clinical trial. In­tensive Care Med 29:834–840Google Scholar
  28. 28.
    Galban C, Montejo JC, Mesejo A et al (2000) An immune-enhancing enteral diet reduces mortality rate and episodes of bacteremia in septic intensive care unit patients. Crit Care Med 28:643–648PubMedGoogle Scholar
  29. 29.
    SorensenJ, KondrupJ, Prokopowicz J et al (2008) EuroOOPS: an international, multicentre study to implement nutritional risk Screening and evaluate clinical outcome. Clin Nutr 27:340–349Google Scholar
  30. 30.
    Weimann A, Braga M, Harsanyi L et al (2006) ESPEN guidelines on enteral nutrition: surgery induding organ transplantation. Clin Nutr 25:224–244PubMedGoogle Scholar
  31. 31.
    Carrere N, Seulin P, Julio CH et al (2007) Is nasogastric or nasojejunal decompression necessary after gastrectomy? A prospective randomized trial. World J Surg 31:122–127PubMedGoogle Scholar
  32. 32.
    Lewis SJ, Egger M, Sylvester PA, Tho­mas S (2001) Early enteral feeding versus„nil by mouth" after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. BMJ 323:773–77Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • M. Hecker
    • 1
  • T.W. Felbinge
    • 2
  • K. Mayer
    • 1
  1. 1.Medizinische Klinik 11 (Pneumologie/internistische Intensivmedizin)Universitätsklinikum Gießen und Marburg, Standort GießenStandort Gießen
  2. 2.Klinik für Anästhesiologie und operative IntensivmedizinKlinikum Neuperlach, Städtisches Klinikum MünchenMünchen

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