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Ernährung und metabolische Kontrolle bei Sepsis

Nutrition and metabolic control in sepsis

  • Leitthema
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Intensivmedizin und Notfallmedizin

Zusammenfassung

Ernährungstherapie bei Intensivpatienten kann mehr sein als nur die Zufuhr von Kalorien. Septische Patienten können einen Vorteil von früher enteraler Ernährung haben. In großen multizentrischen Studien wurde das Konzept der metabolischen Kontrolle auch bei septischen Patienten untersucht, allerdings war eine intensivierte Insulintherapie mit einem Blutzuckerziel von 80–110 mg/dl nicht erfolgreich. Die Ernährung mit einer enteralen Immunonutrition, die bei postoperativen Patienten zu einer Verminderung der Liegezeiten führte, kann bei Patienten mit schwerer Sepsis zu einer Erhöhung der Mortalität führen. Für die parenterale Ernährung sollten neuere Lipidemulsionen genutzt werden, die wahrscheinlich Vorteile für den septischen Patienten bringen. Die intravenöse Supplementierung von langfristig rein parenteral ernährten Intensivpatienten mit Glutamin kann die Sterblichkeit verringern. Eine individuell optimierte und an die Erkrankung angepasste Ernährung ist eine adjunkte Therapie in der Behandlung septischer Patienten.

Abstract

Nutrition in septic patients should be more than just caloric support. Septic patients may benefit from early enteral nutrition. The concept of metabolic control has been evaluated in large multicenter studies in septic patients. However, a tight glycemic control with a blood sugar level target of 80–110 mg/dl was not successful in septic patients. An enteral immunonutrition that resulted in a reduced length of stay in post-operative patients may be associated with increased mortality in patients suffering from severe sepsis. Newly developed lipid emulsions for parenteral nutrition have become available and these emulsions may prove to be beneficial in septic patients. An intravenous supplementation with glutamine of long-term exclusively parenterally fed intensive care patients may reduce mortality. A nutrition individually optimized and adapted to the severity of the disease is an adjunct therapy in the treatment of septic patients.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Dr. Mayer erhielt von den Firmen Abbott, B. Braun, Baxter und Fresenius Kabi Honorare für Vorträge und Konsultationen. Trotz des möglichen Interessenkonflikts ist der Beitrag unabhängig und produktneutral.

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  1. Medizinische Klinik II, University of Giessen Lung Center (UGLC), Universitätsklinikum Gießen und Marburg, Klinikstr. 36, 35392, Gießen, Deutschland

    K. Mayer, H.-D. Walmrath & W. Seeger

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  1. K. Mayer
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  2. H.-D. Walmrath
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  3. W. Seeger
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Correspondence to K. Mayer.

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Mayer, K., Walmrath, HD. & Seeger, W. Ernährung und metabolische Kontrolle bei Sepsis. Intensivmed 46, 541–548 (2009). https://doi.org/10.1007/s00390-009-0114-4

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