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Wieviel Ernährung braucht der Intensivpatient?

How much nutrition is appropriate during critical illness?

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Intensivmedizin und Notfallmedizin

Abstract

Discussion is continuing as to what constitutes optimal nutrition in the critically ill patient. According to the latest meta-analyses of currently available trials, there is agreement that the primary aim should be to initiate enteral nutrition as early as possible. It is still a matter of debate whether and when parenteral nutrition should be started in patients who cannot be appropriately fed by the enteral route. Recently, a grade B recommendation was given for parenteral nutrition in patients in whom enteral nutrition cannot be initiated within 24 hrs after admission to the intensive care unit or injury. Taking into account a caloric target of 24 kcal/kg BW/d the amount of substrates should not exceed: glucose 3 g/kg BW (serum glucose 110–120 mg%), lipids 0.8–1.2 g/kg BW (serum triglycerides <300 mg/dl) and amino acids 1–1.5 g/kg BW. There is high priority to avoid hyperglycemia and -triglyceridemia. Therefore, the caloric target has to be adapted according to substrate tolerance.

Zusammenfassung

In der Diskussion über die bestmögliche künstliche Ernährung des kritisch Kranken besteht auch nach den aktuellen Metaanalysen der verfügbaren Daten Konsens darüber, dass, wenn immer möglich, die enterale Zufuhr zu bevorzugen ist. Wann bei Patienten mit eingeschränkter enteraler Toleranz mit einer parenteralen Ernährung begonnen werden sollte, ist derzeit mangels entsprechender Studien offen. Es gibt jedoch die aktuelle Empfehlung (Grad B), bereits 24 h nach Aufnahme auf der Intensivstation oder nach Trauma mit der parenteralen Ernährung zu beginnen: Hierbei liegen die empfohlenen Zufuhrmengen bei 3–4 g Glukose/kg KG (Blutzuckerspiegel um 110–120 mg%), Lipide 0,8–1,2 g/kg KG (Serumtriglyzeride <300 mg/dl) und Aminosäuren 1–1,5 g/kg/KG. Angestrebt werden sollte eine Kalorienmenge von 24 kcal/kg und Tag. In der katabolen Flowphase gilt für die Vermeidung von Hyperglykämie und -triglyzeridämie höchste Priorität, so dass der Substrattoleranz entsprechend jederzeit das Unterschreiten des Kalorienziels einkalkuliert werden muss.

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Authors and Affiliations

  1. Klinik für Allgemein- und Visceralchirurgie, Städtisches Klinikum „St. Georg“ Leipzig, Delitzscher Str. 141, 04129, Leipzig, Germany

    A. Weimann

  2. Klinik für Anästhesiologie und Intensivmedizin, Eberhard-Karls-Universität Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany

    M. Adolph

  3. Zentrum für Innere Medizin, Medizinische Klinik I, Universitätsklinikum Hamburg-Eppendorf, 20246, Hamburg, Germany

    G. Kreymann

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  1. A. Weimann
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Correspondence to A. Weimann.

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Weimann, A., Adolph, M. & Kreymann, G. Wieviel Ernährung braucht der Intensivpatient?. Intensivmed 44, 31–36 (2007). https://doi.org/10.1007/s00390-007-0770-1

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  • DOI: https://doi.org/10.1007/s00390-007-0770-1

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