Zusammenfassung
Es wird ein Konzept zur einheitlichen enteralen und parenteralen Ernährung schwer kranker Patienten auf der Intensivstation vorgestellt. Das Konzept berücksichtigt die endogene Substratproduktion in der akuten Phase der Erkrankung und vermeidet eine Hyperalimentation. Das Ernährungsziel ergibt sich aus der Multiplikation der Grundrate, d. h. dem Körpergewicht in kg als Laufrate in ml/h (≙ 24 kcal/kg KG/24 h), mit dem Zielfaktor, der zwischen 0,2 und 1,8 liegt. Eine äquivalente Zusammensetzung von enteraler und parenteraler Ernährung ermöglicht den problemlosen Übergang zwischen beiden Ernährungsformen. Gleichzeitig werden immunologische Gesichtspunkte bei der Substratauswahl berücksichtigt und beide Ernährungsformen von einer Zufuhr immunmodulierender Substanzen wie Glutamin und Antioxidantien begleitet.
Abstract
A concept for combined enteral and parenteral nutrition for critically ill patients is described in which endogenous substrate production during the acute phase of illness is taken into consideration and hyperalimentation is avoided. The nutritional goal is defined by multiplication of the base rate, i.e. body weight (BW) in kg as delivery rate in ml/h (≙ 24 kcal/kg BW/24 h), with a target factor, which varies between 0.2 and 1.8. An equivalent composition of enteral and parenteral nutrition allows a transition between both forms without problems. Simultaneously, immunologic aspects of nutrition are considered as well and both forms of nutrition are complemented by immune-modulating substrates such as glutamine and antioxidants.
Notes
Das hier beschriebene Konzept wurde in Zusammenarbeit mit der Firma Fresenius Kabi Deutschland GmbH entwickelt.
Literatur
Alexander JW, Gonce SJ, Miskell PW et al. (1989) A new model for studying nutrition in peritonitis: the adverse effect of overfeeding. Ann Surg 209: 334–340
Angstwurm MW, Engelmann L, Zimmermann T et al. (2007) Selenium in Intensive Care (SIC): results of a prospective randomized, placebo-controlled, multiple-center study in patients with severe systemic inflammatory response syndrome, sepsis, and septic shock. Crit Care Med 35: 118–126
Aulick LH, Wilmore DW (1979) Increased peripheral amino acid release following burn injury. Surgery 85: 560–565
Battistella FD, Widergren JT, Anderson JT et al. (1997) A prospective, randomized trial of intravenous fat emulsion administration in trauma victims requiring total parenteral nutrition. J Trauma 43: 52–58
Braunschweig CL, Levy P, Sheean PM et al. (2001) Enteral compared with parenteral nutrition: a meta-analysis. Am J Clin Nutr 74: 534–542
Carpentier YA, Dupont IE (2000) Advances in intravenous lipid emulsions. World J Surg 24: 1493–1497
Cuthbertson DP (1942) Post-shock metabolic response. Lancet 1: 433–437
Dhaliwal R, Jurewitsch B, Harrietha D et al. (2004) Combination enteral and parenteral nutrition in critically ill patients: harmful or beneficial? A systematic review of the evidence. Intensive Care Med 30: 1666–1671
Gabay C, Kushner I (1999) Acute-phase proteins and other systemic responses to inflammation [published erratum appears in N Engl J Med 340: 1376]. N Engl J Med 340: 448–454
Gadek JE, DeMichele SJ, Karlstad MD et al. (1999) Effect of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in patients with acute respiratory distress syndrome. Enteral Nutrition in ARDS Study Group. Crit Care Med 27: 1409–1420
Grimm H, Mertes N, Goeters C et al. (2006) Improved fatty acid and leukotriene pattern with a novel lipid emulsion in surgical patients. Eur J Nutr 45: 55–60
Hasselgren PO (1995) Muscle protein metabolism during sepsis. Biochem Soc Trans 23: 1019–1025
Heyland DK, Dhaliwal R, Day AG et al. (2006) REducing Deaths due to OXidative Stress (The REDOXS Study): rationale and study design for a randomized trial of glutamine and antioxidant supplementation in critically-ill patients. Proc Nutr Soc 65: 250–263
Heyland DK, Dhaliwal R, Drover JW et al. (2003) Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. J Parenter Enteral Nutr 27: 355–373
Heyland DK, Dhaliwalm R, Day A et al. (2007) Optimizing the dose of glutamine dipeptides and antioxidants in critically ill patients: a phase I dose-finding study. J Parenter Enteral Nutr 31: 109–118
Heyland DK, Novak F, Drover JW et al. (2001) Should immunonutrition become routine in critically ill patients? A systematic review of the evidence. JAMA 286: 944–953
Kreymann G, Ebener C, Hartl W et al. (2003) DGEM-Leitlinie Enterale Ernährung: Intensivmedizin. Akt Ern Med 28: S42–S50
Kreymann KG, Berger MM, Deutz NE et al. (2006) ESPEN Guidelines on Enteral Nutrition: Intensive care. Clin Nutr 25: 210–223
Krishnan JA, Parce PB, Martinez A et al. (2003) Caloric intake in medical ICU patients: consistency of care with guidelines and relationship to clinical outcomes. Chest 124: 297–305
Mertes N, Grimm H, Furst P et al. (2006) Safety and efficacy of a new parenteral lipid emulsion (SMOFlipid) in surgical patients: a randomized, double-blind, multicenter study. Ann Nutr Metab 50: 253–259
Mizock BA (1995) Alterations in carbohydrate metabolism during stress: a review of the literature. Am J Med 98: 75–84
Moore FD, Olesen KH, McMurrey JD et al. (1963) The body cell mass and its supporting environment: body composition in health and disease. Saunders, Philadelphia
Novak F, Heyland DK, Avenell A et al. (2002) Glutamine supplementation in serious illness: a systematic review of the evidence. Crit Care Med 30: 2022–2029
Pearl RH, Clowes GH Jr, Hirsch EF et al. (1985) Prognosis and survival as determined by visceral amino acid clearance in severe trauma. J Trauma 25: 777–783
Peck MD, Alexander JW, Gonce SJ et al. (1989) Low protein diets improve survival from peritonitis in guinea pigs. Ann Surg 209: 448–454
Pontes-Arruda A, Aragao AM, Albuquerque JD (2006) Effects of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in mechanically ventilated patients with severe sepsis and septic shock. Crit Care Med 34: 2325–2333
Rolih CA, Ober KP (1995) The endocrine response to critical illness. Med Clin North Am 79: 211–224
Rosenblatt S, Clowes GH Jr, George BC et al. (1983) Exchange of amino acids by muscle and liver in sepsis. Arch Surg 118: 167–175
Singer P, Theilla M, Fisher H et al. (2006) Benefit of an enteral diet enriched with eicosapentaenoic acid and gamma-linolenic acid in ventilated patients with acute lung injury. Crit Care Med 34: 1033–1038
Souba WW (1994) Cytokine control of nutrition and metabolism in critical illness. Curr Probl Surg 31: 577–643
Stoner HB, Little RA, Frayn KN et al. (1983) The effect of sepsis on the oxidation of carbohydrate and fat. Br J Surg 70: 32–35
Tappy L, Schwarz JM, Schneiter P et al. (1998) Effects of isoenergetic glucose-based or lipid-based parenteral nutrition on glucose metabolism, de novo lipogenesis, and respiratory gas exchanges in critically ill patients. Crit Care Med 26: 860–867
White RH, Frayn KN, Little RA et al. (1987) Hormonal and metabolic responses to glucose infusion in sepsis studied by the hyperglycemic glucose clamp technique. J Parent Ent Nutrition 11: 345–353
Wichmann MW, Thul P, Czarnetzki HD et al. (2007) Evaluation of clinical safety and beneficial effects of a fish oil containing lipid emulsion (Lipoplus, MLF541): data from a prospective, randomized, multicenter trial. Crit Care Med 35: 700–706
Wischmeyer PE (2003) Clinical applications of L-glutamine: past, present, and future. Nutr Clin Pract 18: 377–385
Interessenskonflikt
K.G.K. hat ein Honorar für die Entwicklung des Konzeptes von Fresenius Kabi Deutschland GmbH enthalten, außerdem Vortragshonorare von Baxter Deutschland GmbH, B. Braun Melsungen AG und Fresenius Kabi Deutschland GmbH. R.M. hat Vortragshonorare von Baxter Deutschland GmbH, B. Braun Melsungen AG und Fresenius Kabi Deutschland GmbH erhalten. T.F. u. R.F.M. haben Vortragshonorare von Fresenius Kabi Deutschland GmbH erhalten.
Author information
Authors and Affiliations
Corresponding author
Additional information
__ ____
Dieser Artikel erschien in veränderter Form auch in Pneumologie 2007, 61 (im Druck)
Rights and permissions
About this article
Cite this article
Kreymann, K., de Heer, G., Felbinger, T. et al. Ernährung kritisch Kranker auf der Intensivstation. Internist 48, 1084–1092 (2007). https://doi.org/10.1007/s00108-007-1926-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00108-007-1926-6