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Monitoring der künstlichen Ernährung bei kritisch kranken Patienten

Monitoring nutritional support in critically ill patients

  • Leitthema
  • Published:
Intensivmedizin und Notfallmedizin

Zusammenfassung

Jede Form der künstlichen Ernährung ist mit Komplikationen verbunden, die jedoch durch regelmäßige Effizienzkontrollen minimiert werden können. Bei kritisch Kranken kann die Einschätzung des Ernährungszustands sonographisch (Muskelmasse) oder mittels Subjective Global Assessment (SGA) erfolgen. Bei enteraler Ernährung ist die Aspiration eine gefürchtete Komplikation. Zur Minimierung des Risikos gehört die Überwachung der gastrointestinalen Motilität, die häufig gestört ist und dadurch eine bedarfsgerechte Ernährung verhindert wird. Daher muss die Menge der zugeführten bzw. mutmaßlich resorbierten Kalorien engmaschig überwacht werden. Unter parenteraler Ernährung können Hyperglykämien und Hypertriglyzeridämien exazerbieren; hier sind die Blutzucker- und Triglyzeridkonzentrationen engmaschig zu überwachen. Weiterhin kann sich eine Fettleber entwickeln, evt. in Verbindung mit biliären Komplikationen, welche sich durch Bestimmung der hepatischen Funktionsparameter im Plasma erkennen lassen. Patienten mit Nierenfunktionsstörungen bzw. ausgeprägten Volumenverschiebungen benötigen zusätzlich engmaschige Kontrollen der Elektrolytkonzentrationen, der Vitalfunktionen, des Hydratationszustandes sowie der Nierenfunktion.

Abstract

Independent from its type or mode, artificial nutrition may cause complications. In critical illness, it may be particularly difficult to evaluate the nutritional status of an individual patient. Accepting some degree of imprecision, muscle ultrasound and subjective global assessment may be valuable tools. During enteral nutrition, aspiration is the complication feared the most. To minimize corresponding risks, it is important to closely monitor gastrointestinal function which is likely to be impaired, thereby, often preventing the provision of sufficient calories. To account for potential deficits, a close monitoring of actually administered or presumably absorbed calories is essential. During parenteral nutrition, the risk is high that hyperglycemia or hypertriglyceridemia will exacerbate. Consequently, corresponding concentrations need to be closely monitored. Further complications include generation of a fatty liver, or biliary pathologies. The latter can be recognized by regularly determining plasmatic parameters of hepatic function. In patients with impaired kidney function or large volume shifts, close surveillance of electrolyte concentrations, vital function, hydration state, and kidney function is essential.

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  1. Chirurgische Klinik und Poliklinik der Universität, Campus Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland

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Hartl, W., Kuppinger, D. Monitoring der künstlichen Ernährung bei kritisch kranken Patienten. Intensivmed 48, 99–108 (2011). https://doi.org/10.1007/s00390-010-0220-3

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