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2016 | OriginalPaper | Buchkapitel

12. Ernährung und Dysfunktion von Leber und Magen-Darm-Trakt

verfasst von : Prof. Dr. med. M. Bauer, Prof. Dr. med. K. Werdan, Prof. Dr. med. K. Mayer, Priv.-Doz. Dr. med. M. Hecker, Prof. Dr. med. M.A. Weigand

Erschienen in: Sepsis und MODS

Verlag: Springer Berlin Heidelberg

Zusammenfassung

Störungen der Leber(teil)funktionen sind für Verlauf und Prognose des Patienten mit Multiorgandysfunktion von maßgeblicher Bedeutung und werden bei alleiniger Betrachtung von Serumtransaminasen und Bilirubin unterschätzt. Umgekehrt bestimmen extrahepatische Komplikationen, wie hepatorenales Syndrom und hepatische Enzephalopathie, die Prognose des akuten Leberversagens. Neben spezifischen oder kausalen Therapiemöglichkeiten stehen im Rahmen von Studien verschiedene Varianten der Albumindialyse zur Verfügung.
Dysfunktionen und Schäden des Magen-Darm-Trakts („gastrointestinal failure“, GIF; „acute gastrointestinal injury“, AGI) sind bei schwerer Sepsis, bei Schockzuständen und MODS häufig.
Die Ernährung ist mehr als ein reiner Kalorienlieferant, sondern vielmehr eine akzeptierte supportive Therapieform. Eine parenterale Ernährung stellt eine Ergänzung oder den Ersatz der enteralen Ernährung dar. Immunmodulierende Substanzen werden in der Ernährungstherapie ebenfalls seit Langem eingesetzt.
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Zurück zum Zitat Montejo JC, Minambres E, Bordeje L, Mesejo A, Acosta J, Heras A, Ferre M, Fernandez-Ortega F, Vaquerizo CI, Manzanedo R (2010) Gastric residual volume during enteral nutrition in ICU patients: the REGANE study. Intensive Care Med 36: 1386–1393CrossRefPubMed Montejo JC, Minambres E, Bordeje L, Mesejo A, Acosta J, Heras A, Ferre M, Fernandez-Ortega F, Vaquerizo CI, Manzanedo R (2010) Gastric residual volume during enteral nutrition in ICU patients: the REGANE study. Intensive Care Med 36: 1386–1393CrossRefPubMed
Zurück zum Zitat Petrof EO, Dhaliwal R, Manzanares W, Johnstone J, Cook D, Heyland DK (2012) Probiotics in the critically ill: a systematic review of the randomized trial evidence. Crit Care Med 40: 3290–3302CrossRefPubMed Petrof EO, Dhaliwal R, Manzanares W, Johnstone J, Cook D, Heyland DK (2012) Probiotics in the critically ill: a systematic review of the randomized trial evidence. Crit Care Med 40: 3290–3302CrossRefPubMed
Zurück zum Zitat Pontes-Arruda A, Martins LF, de Lima SM, Isola AM, Toledo D, Rezende E, Maia M, Magnan GB; Investigating Nutritional Therapy with EPA, GLA and Antioxidants Role in Sepsis Treatment (Intersept) Study Group (2011) Enteral nutrition with eicosapentaenoic acid, gamma-linolenic acid and antioxidants in the early treatment of sepsis: results from a multicenter, prospective, randomized, double-blinded, controlled study: the INTERSEPT Study. Crit Care 15: R144PubMedCentralCrossRefPubMed Pontes-Arruda A, Martins LF, de Lima SM, Isola AM, Toledo D, Rezende E, Maia M, Magnan GB; Investigating Nutritional Therapy with EPA, GLA and Antioxidants Role in Sepsis Treatment (Intersept) Study Group (2011) Enteral nutrition with eicosapentaenoic acid, gamma-linolenic acid and antioxidants in the early treatment of sepsis: results from a multicenter, prospective, randomized, double-blinded, controlled study: the INTERSEPT Study. Crit Care 15: R144PubMedCentralCrossRefPubMed
Zurück zum Zitat Poulard F, Dimet J, Martin-Lefevre L, Bontemps F, Fiancette M, Clementi E, Lebert C, Renard B, Reignier J (2010) Impact of not measuring residual gastric volume in mechanically ventilated patients receiving early enteral feeding: a prospective before-after study. JPEN J Parenter Enteral Nutr 34: 125–130CrossRefPubMed Poulard F, Dimet J, Martin-Lefevre L, Bontemps F, Fiancette M, Clementi E, Lebert C, Renard B, Reignier J (2010) Impact of not measuring residual gastric volume in mechanically ventilated patients receiving early enteral feeding: a prospective before-after study. JPEN J Parenter Enteral Nutr 34: 125–130CrossRefPubMed
Zurück zum Zitat Pradelli L, Mayer K, Muscaritoli M, Heller AR (2012) n-3 fatty acid-enriched parenteral nutrition regimens in elective surgical and ICU patients: a meta-analysis. Crit Care 16: R184PubMedCentralCrossRefPubMed Pradelli L, Mayer K, Muscaritoli M, Heller AR (2012) n-3 fatty acid-enriched parenteral nutrition regimens in elective surgical and ICU patients: a meta-analysis. Crit Care 16: R184PubMedCentralCrossRefPubMed
Zurück zum Zitat Reignier J, Mercier E, Le Gouge A, Boulain T, Desachy A, Bellec F, Clavel M, Frat JP, Plantefeve G, Quenot JP, Lascarrou JB (2013) Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial. JAMA 309: 249–256CrossRefPubMed Reignier J, Mercier E, Le Gouge A, Boulain T, Desachy A, Bellec F, Clavel M, Frat JP, Plantefeve G, Quenot JP, Lascarrou JB (2013) Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial. JAMA 309: 249–256CrossRefPubMed
Zurück zum Zitat Reinhart K, Brunkhorst FM, Bone HG, Bardutzky J, Dempfle CE, Forst H, Gastmeier P, Gerlach H, Grundling M, John S, Kern W, Kreymann G, Kruger W, Kujath P, Marggraf G, Martin J, Mayer K, Meier-Hellmann A, Oppert M, Putensen C, Quintel M, Ragaller M, Rossaint R, Seifert H, Spies C, Stuber F, Weiler N, Weimann A, Werdan K, Welte T (2010) Prävention, Diagnose, Therapie und Nachsorge der Sepsis. Erste Revision der S2k-Leitlinien der Deutschen Sepsis-Gesellschaft e.V. (DSG) und der Deutschen Interdisziplinären Vereinigugn für Intensiv- und Notfallmedizin (DIVI). Anaesthesist 59: 347–370CrossRefPubMed Reinhart K, Brunkhorst FM, Bone HG, Bardutzky J, Dempfle CE, Forst H, Gastmeier P, Gerlach H, Grundling M, John S, Kern W, Kreymann G, Kruger W, Kujath P, Marggraf G, Martin J, Mayer K, Meier-Hellmann A, Oppert M, Putensen C, Quintel M, Ragaller M, Rossaint R, Seifert H, Spies C, Stuber F, Weiler N, Weimann A, Werdan K, Welte T (2010) Prävention, Diagnose, Therapie und Nachsorge der Sepsis. Erste Revision der S2k-Leitlinien der Deutschen Sepsis-Gesellschaft e.V. (DSG) und der Deutschen Interdisziplinären Vereinigugn für Intensiv- und Notfallmedizin (DIVI). Anaesthesist 59: 347–370CrossRefPubMed
Zurück zum Zitat Rice TW, Wheeler AP, Thompson BT, deBoisblanc BP, Steingrub J, Rock P; NIH NHLBI Acute Respiratory Distress Syndrome Network of Investigators (2011) Enteral omega-3 fatty acid, gamma-linolenic acid, and antioxidant supplementation in acute lung injury. JAMA 306: 1574–1581PubMedCentralCrossRefPubMed Rice TW, Wheeler AP, Thompson BT, deBoisblanc BP, Steingrub J, Rock P; NIH NHLBI Acute Respiratory Distress Syndrome Network of Investigators (2011) Enteral omega-3 fatty acid, gamma-linolenic acid, and antioxidant supplementation in acute lung injury. JAMA 306: 1574–1581PubMedCentralCrossRefPubMed
Zurück zum Zitat Rice TW, Wheeler AP, Thompson BT, Steingrub J, Hite RD, Moss M, Morris A, Dong N, Rock P; National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network (2012) Initial trophic vs full enteral feeding in patients with acute lung injury: the EDEN randomized trial. JAMA 307: 795–803 [Die randomisierte Studie belegt, dass für Patienten mit erwarteter kurzer Liegezeit auf der Intensivstation und geringem Sterberisiko eine geringe Kalorienzufuhr ausreichend ist.] ← Rice TW, Wheeler AP, Thompson BT, Steingrub J, Hite RD, Moss M, Morris A, Dong N, Rock P; National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network (2012) Initial trophic vs full enteral feeding in patients with acute lung injury: the EDEN randomized trial. JAMA 307: 795–803 [Die randomisierte Studie belegt, dass für Patienten mit erwarteter kurzer Liegezeit auf der Intensivstation und geringem Sterberisiko eine geringe Kalorienzufuhr ausreichend ist.] ←
Zurück zum Zitat Rubinson L, Diette GB, Song X, Brower RG, Krishnan JA (2004) Low caloric intake is associated with nosocomial bloodstream infections in patients in the medical intensive care unit. Crit Care Med 32: 350–357CrossRefPubMed Rubinson L, Diette GB, Song X, Brower RG, Krishnan JA (2004) Low caloric intake is associated with nosocomial bloodstream infections in patients in the medical intensive care unit. Crit Care Med 32: 350–357CrossRefPubMed
Zurück zum Zitat Siempos, II, Ntaidou TK, Falagas ME (2010) Impact of the administration of probiotics on the incidence of ventilator-associated pneumonia: a meta-analysis of randomized controlled trials. Crit Care Med 38: 954–962CrossRefPubMed Siempos, II, Ntaidou TK, Falagas ME (2010) Impact of the administration of probiotics on the incidence of ventilator-associated pneumonia: a meta-analysis of randomized controlled trials. Crit Care Med 38: 954–962CrossRefPubMed
Zurück zum Zitat Simpson F, Doig GS (2005) Parenteral vs. enteral nutrition in the critically ill patient: a meta-analysis of trials using the intention to treat principle. Intensive Care Med 31: 12–23CrossRefPubMed Simpson F, Doig GS (2005) Parenteral vs. enteral nutrition in the critically ill patient: a meta-analysis of trials using the intention to treat principle. Intensive Care Med 31: 12–23CrossRefPubMed
Zurück zum Zitat Singer P, Berger MM, Van den Berghe G, Biolo G, Calder P, Forbes A, Griffiths R, Kreyman G, Leverve X, Pichard C ESPEN (2009) ESPEN Guidelines on Parenteral Nutrition: intensive care. Clin Nutr 28: 387–400CrossRefPubMed Singer P, Berger MM, Van den Berghe G, Biolo G, Calder P, Forbes A, Griffiths R, Kreyman G, Leverve X, Pichard C ESPEN (2009) ESPEN Guidelines on Parenteral Nutrition: intensive care. Clin Nutr 28: 387–400CrossRefPubMed
Zurück zum Zitat Singer P, Anbar R, Cohen J, Shapiro H, Shalita-Chesner M, Lev S, Grozovski E, Theilla M, Frishman S, Madar Z (2011) The tight calorie control study (TICACOS): a prospective, randomized, controlled pilot study of nutritional support in critically ill patients. Intensive Care Med 37: 601–609CrossRefPubMed Singer P, Anbar R, Cohen J, Shapiro H, Shalita-Chesner M, Lev S, Grozovski E, Theilla M, Frishman S, Madar Z (2011) The tight calorie control study (TICACOS): a prospective, randomized, controlled pilot study of nutritional support in critically ill patients. Intensive Care Med 37: 601–609CrossRefPubMed
Zurück zum Zitat Stoner HB, Little RA, Frayn KN, Elebute AE, Tresadern J, Gross E (1983) The effect of sepsis on the oxidation of carbohydrate and fat. Br J Surg 70: 32–35CrossRefPubMed Stoner HB, Little RA, Frayn KN, Elebute AE, Tresadern J, Gross E (1983) The effect of sepsis on the oxidation of carbohydrate and fat. Br J Surg 70: 32–35CrossRefPubMed
Zurück zum Zitat Suchner U, Katz DP, Furst P, Beck K, Felbinger TW, Senftleben U, Thiel M, Goetz AE, Peter K (2001) Effects of intravenous fat emulsions on lung function in patients with acute respiratory distress syndrome or sepsis. Crit Care Med 29: 1569–1574CrossRefPubMed Suchner U, Katz DP, Furst P, Beck K, Felbinger TW, Senftleben U, Thiel M, Goetz AE, Peter K (2001) Effects of intravenous fat emulsions on lung function in patients with acute respiratory distress syndrome or sepsis. Crit Care Med 29: 1569–1574CrossRefPubMed
Zurück zum Zitat van den Berghe G Wouters P Weekers F Verwaest C Bruyninckx F Schetz M Vlasselaers D Ferdinande P Lauwers P Bouillon R (2001) Intensive insulin therapy in the critically ill patients. N Engl J Med 345: 1359–1367CrossRefPubMed van den Berghe G Wouters P Weekers F Verwaest C Bruyninckx F Schetz M Vlasselaers D Ferdinande P Lauwers P Bouillon R (2001) Intensive insulin therapy in the critically ill patients. N Engl J Med 345: 1359–1367CrossRefPubMed
Zurück zum Zitat Villet S, Chiolero RL, Bollmann MD, Revelly JP, Cayeux RNM, Delarue J, Berger MM (2005) Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. Clin Nutr 24: 502–509 [Die retrospektive Analyse zeigt auf, dass ein initiales Kaloriendefizit bei kritisch Kranken mit einer erhöhten Rate an Infektonen und weiteren Komplikationen korreliert.] ← Villet S, Chiolero RL, Bollmann MD, Revelly JP, Cayeux RNM, Delarue J, Berger MM (2005) Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. Clin Nutr 24: 502–509 [Die retrospektive Analyse zeigt auf, dass ein initiales Kaloriendefizit bei kritisch Kranken mit einer erhöhten Rate an Infektonen und weiteren Komplikationen korreliert.] ←
Metadaten
Titel
Ernährung und Dysfunktion von Leber und Magen-Darm-Trakt
verfasst von
Prof. Dr. med. M. Bauer
Prof. Dr. med. K. Werdan
Prof. Dr. med. K. Mayer
Priv.-Doz. Dr. med. M. Hecker
Prof. Dr. med. M.A. Weigand
Copyright-Jahr
2016
Verlag
Springer Berlin Heidelberg
DOI
https://doi.org/10.1007/978-3-662-45148-9_12

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