Aminosäuren sind die biologischen Baustoffe für alle Struktur- und Funktionsproteine. Da jede Erkrankung mit einem Abbau dieser Proteine einhergeht, ist die Zufuhr von Protein bzw. Aminosäuren essenziell für deren Resynthese. Derzeit gibt es keine Möglichkeit, die endogene Aminosäurefreisetzung zu bestimmen. So bleiben Zeitpunkt und Dosierung der Proteinzufuhr beim kritisch Kranken weiterhin Gegenstand der Diskussion.
Abstract
Critical illness is associated with a loss of body protein and skeletal muscle. Of 18 heterogenous randomized studies evaluating different doses of protein, 15 (83 %) found better results with a higher dose, which ranged from 1.1 to 3.6 g/kg/day. As the degree of catabolism varies with different diseases, there can be no optimal protein dose for all patients. However, clinical evidence is still week as only nitrogen balance was the primary endpoint in most of these trials. Observational studies showed a time dependency of the protein dose and lowest mortality with a dose ≥ 1.2 g/kg/day on and after day 4 or 6. However, in septic patients in the acute phase of infection the provision of > 1.2 g/kg/day of protein was associated with a higher mortality in one observational study. For future research, randomized studies should be performed on groups of patients with a defined protein loss. Also, protein dose should be related to lean body mass.
Schlüsselwörter
Proteindosis - kritisch Kranke - Körpermagermasse - Proteinäquivalent
Keywords
protein dose - critically ill - lean body mass
