Empfehlungen und Innovationen in der Ernährungsmedizin für kritisch Kranke

Die medizinische Ernährungstherapie ist ein zentraler Bestandteil der Therapie auf Intensivstationen und spielt eine entscheidende Rolle für die Prognose kritisch kranker Patient*innen. Eine individualisierte Ernährungsstrategie ist essenziell, um den besonderen Bedürfnissen kritisch kranker Patient*innen gerecht zu werden und mögliche Komplikationen zu minimieren.

Abstract

Medical Nutrition Therapy (MNT) is a key component of treatment in intensive care units (ICU) and plays a crucial role in the prognosis of critically ill patients. An individualized nutrition strategy is essential to meet the specific needs of critically ill patients and to minimize potential complications.

Recommendations for MNT differ between the guidelines of the German Society for Nutritional Medicine (DGEM), the European Society for Clinical Nutrition and Metabolism (ESPEN), and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), making its implementation in clinical practice challenging. Therefore, the first part of this article provides a pragmatic summary of the current recommendations for everyday clinical practice. The second part focuses on recent data and how these might influence current paradigms of MNT for critically ill patients, with particular emphasis on phase-appropriate macronutrient delivery and combinations of nutrition with other interventions.

Kernaussagen

• Die Ernährung kritisch Kranker ist eine adjuvante medizinische Therapie, die individuelle Planung und sorgfältige Adaptation an den aktuellen gastrointestinalen und metabolischen Status der Intensivpatient*innen benötigt.

• In den letzten Jahren haben große multizentrische Studien hierbei einen Paradigmenwechsel bewirkt.

• Angesichts der aktuellen Datenlage erscheint es ratsam, bei ITS-Aufnahme den Ernährungsstatus abzuschätzen und möglichst die Körperzusammensetzung zu bestimmen.

• Die MNT sollte innerhalb der ersten 24–48 h starten; bei den meisten Patient*innen ist mit einer enteralen Standardsondenkost zu beginnen.

• Die initiale Laufrate ist niedrig zu wählen (sowohl bei enteraler als auch parenteraler Ernährung).

• Verschiedene Routen der Ernährungszufuhr können kombiniert werden, um die Versorgung mit der individuell angepassten Therapie sicherzustellen.

• Mindestens 1-mal pro Schicht sind die aufgenommene Nahrungsmenge und die gastrointestinale Toleranz zu evaluieren und die Therapie daran anzupassen.

• Es sollte ein interdisziplinärer und multiprofessioneller Therapieansatz verfolgt werden.

Schlüsselwörter

medizinische Ernährungstherapie - Ernährung - kritische Erkrankungen - Intensivpatient - Makronährstoff - Mikronährstoff - Übersichtsarbeit

Keywords

medical nutrition therapy - nutrition - critical illness - intensive care patient - macronutrient - micronutrient - review article

Publication History

Article published online:
24 March 2025

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