Zusammenfassung
Es zeigt sich zunehmend, dass die Ernährung des kritisch kranken Patienten eine hoch komplexe Tätigkeit mit derzeit noch vielen offenen Fragen ist. Zahlreiche Untersuchungen belegen, dass eine frühzeitige enterale Ernährung hilft, Komplikationen zu vermeiden. Es wurde ferner gezeigt, dass das Kalorienziel als alleiniges Ernährungsziel eher eine untergeordnete Rolle spielt, wenn man auf ausreichend Zufuhr von Proteinen achtet. Die Ernährung der unterschiedlichen Patientenkollektive mit ihren sehr individuellen physiologischen Voraussetzungen und ihren sehr unterschiedlichen Erkrankungen stellt eine weitere diffizile Fragestellung in der Ernährungstherapie dar. Die enterale Ernährung scheint derzeit eindeutig den besten Zugangsweg darzustellen, wobei es offensichtlich keinen klaren Vorteil für die gastrale oder jejunale Gabe gibt. Doch scheint auf Grund der leichteren Sondenplatzierung der gastrale Weg im Alltag der praktikablere zu sein. Auch die Refluxkontrolle wird derzeit sehr diskutiert. Um die intestinale Transportleistung abschätzen zu können, bleibt eine Kontrolle des Refluxes unumgänglich. Welche Refluxmenge jedoch als Cut-off-Kriterium gelten sollte, ist derzeit noch ungeklärt. Auch der Bereich der Immunonutrition oder der Substitution von Selen, Glutamin und anderer Substanzen ist derzeit noch ungeklärt. Der vorliegende Beitrag gibt eine Literaturübersicht über aktuelle Standards in der Ernährungstherapie des Intensivpatienten.
Abstract
It is increasingly recognized that the nutrition of critically ill patients is a highly complex activity with many unanswered questions. Much research has been performed showing that early enteral nutrition helps to avoid complications. In addition, it has already been shown that the calorie goal as the sole diet goal rather plays a minor role, if one pays attention to sufficient supply of proteins. The diet of the different patient groups with their very individual physiological conditions and their very different diseases are another difficile question in nutritional therapy. The question about the best access path currently appears clearly to be the way of enteral nutrition. Although there seems to be no clear advantage to the gastric or jejunal route, the gastric tube is apparently used more often in clinical practice due to the ease of placement. Reflux control is also currently controversially discussed. To assess the intestinal transport capacity, control of reflux is inevitable, but the amount of reflux that should be considered as cut-off criteria is still unclear. The field of immunonutrition or the substitution of selenium, glutamine, and other substances requires further research. The goal of this article is to provide the reader with a review of the current literature concerning nutritional needs of intensive care patients.
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Interessenkonflikt. A. Schäfer gibt an, dass kein Interessenkonflikt besteht.
Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Schäfer, A. Kalorien, Proteine – was braucht der Intensivpatient?. Med Klin Intensivmed Notfmed 109, 52–60 (2014). https://doi.org/10.1007/s00063-013-0303-6
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DOI: https://doi.org/10.1007/s00063-013-0303-6
Schlüsselwörter
- Ernährungsanforderungen
- Protein-Energie-Fehlernährung
- Biologisches Monitoring
- Parenterale Infusionen
- Metabolismus