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Ernährung und Immunonutrition bei Sepsis

Nutrition and immunonutrition in septic patients

  • Schwerpunkt: Intensivmedizin
  • Published:
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Zusammenfassung

Die Ernährungstherapie bei Intensivpatienten ist mehr als die Zufuhr von Kalorien. Nicht alle Konzepte der Ernährung aus der allgemeinen Intensivmedizin sind direkt auf septische Patienten übertragbar. Eine enge Glukosekontrolle durch intensivierte Insulintherapie, erfolgreich bei postoperativen Intensivpatienten angewandt, muss für septische Patienten modifiziert werden. Die Ernährung mit enteraler 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 stehen weiter entwickelte Lipidemulsionen zur Verfügung, die wahrscheinlich Vorteile für den septischen Patienten mit sich bringen. Die intravenöse Supplementierung von langfristig rein parenteral ernährten Intensivpatienten mit Glutamin kann möglicherweise die Sterblichkeit verringern. Insgesamt ist eine individuell optimierte und an die Erkrankung angepasste Ernährung als adjunkte Therapieform ein wichtiger Baustein des Gesamttherapiekonzepts der Sepsis.

Abstract

Nutrition in septic patients is more than just caloric support. Not all nutritional concepts in general intensive care may be applied to septic patients. A tight glycemic control successfully used in post-operative intensive care patients has to be modified for the septic patient. Enteral immunonutrition leading to 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 became available. Application of 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 their mortality. A nutrition individually optimized and adapted to the severity of the disease is considered to be an adjunct therapeutic measure in the treatment concept in sepsis.

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Interessenkonflikt

Dr. Mayer erhielt von den Firmen BBraun, Baxter, Bayer, Fresenius Kabi und Pfizer Honorare für Vorträge und Konsultationen.

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Authors and Affiliations

  1. University of Giessen Lung Center (UGLC), Medizinische Klinik II am Universitätsklinikum Gießen und Marburg

    M. B. Schaefer, H. D. Walmrath, F. Grimminger & W. Seeger

  2. University of Giessen Lung Center, Medizinische Klinik II, Klinikstraße 36, 35392, Gießen

    K. Mayer

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  1. K. Mayer
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Correspondence to K. Mayer.

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Mayer, K., Schaefer, M.B., Walmrath, H.D. et al. Ernährung und Immunonutrition bei Sepsis. Internist 47, 374–382 (2006). https://doi.org/10.1007/s00108-006-1592-0

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