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Erschienen in: Der Internist 4/2006

01.04.2006 | Schwerpunkt: Intensivmedizin

Ernährung und Immunonutrition bei Sepsis

verfasst von: Dr. K. Mayer, M. B. Schaefer, H. D. Walmrath, F. Grimminger, W. Seeger

Erschienen in: Die Innere Medizin | Ausgabe 4/2006

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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.
Literatur
2.
Zurück zum Zitat Agwunobi AO, Reid C, Maycock P, Little RA, Carlson GL (2000) Insulin resistance and substrate utilization in human endotoxemia. J Clin Endocrinol Metab 85: 3770–3778CrossRefPubMed Agwunobi AO, Reid C, Maycock P, Little RA, Carlson GL (2000) Insulin resistance and substrate utilization in human endotoxemia. J Clin Endocrinol Metab 85: 3770–3778CrossRefPubMed
3.
Zurück zum Zitat Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29: 1303–1310CrossRefPubMed Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29: 1303–1310CrossRefPubMed
4.
Zurück zum Zitat Atkinson S, Sieffert E, Bihari D (1998) A prospective, randomized, double-blind, controlled clinical trial of enteral immunonutrition in the critically ill. Guy’s Hospital Intensive Care Group. Crit Care Med 26: 1164–1172CrossRefPubMed Atkinson S, Sieffert E, Bihari D (1998) A prospective, randomized, double-blind, controlled clinical trial of enteral immunonutrition in the critically ill. Guy’s Hospital Intensive Care Group. Crit Care Med 26: 1164–1172CrossRefPubMed
5.
Zurück zum Zitat Barr J, Hecht M, Flavin KE, Khorana A, Gould MK (2004) Outcomes in critically ill patients before and after the implementation of an evidence-based nutritional management protocol. Chest 125: 1446–1457CrossRefPubMed Barr J, Hecht M, Flavin KE, Khorana A, Gould MK (2004) Outcomes in critically ill patients before and after the implementation of an evidence-based nutritional management protocol. Chest 125: 1446–1457CrossRefPubMed
6.
Zurück zum Zitat Battistella FD, Widergren JT, Anderson JT, Siepler JK, Weber JC, MacColl K (1997) A prospective, randomized trial of intravenous fat emulsion administration in trauma victims requiring total parenteral nutrition. J Trauma 43: 52–58PubMed Battistella FD, Widergren JT, Anderson JT, Siepler JK, Weber JC, MacColl K (1997) A prospective, randomized trial of intravenous fat emulsion administration in trauma victims requiring total parenteral nutrition. J Trauma 43: 52–58PubMed
7.
Zurück zum Zitat Bertolini G, Iapichino G, Radrizzani D et al. (2003) Early enteral immunonutrition in patients with severe sepsis: results of an interim analysis of a randomized multicentre clinical trial. Intensive Care Med 29: 834–840CrossRefPubMed Bertolini G, Iapichino G, Radrizzani D et al. (2003) Early enteral immunonutrition in patients with severe sepsis: results of an interim analysis of a randomized multicentre clinical trial. Intensive Care Med 29: 834–840CrossRefPubMed
8.
Zurück zum Zitat Brunkhorst FM, Kuhnt E, Engel C et al.; SepNet GCNS (2005) Intensive insulin therapy in patients with severe sepsis and septic shock is associated with an increased rate of hypoglycemia – results from a randomized multicenter study (VISEP). Infection 33: 19–20 Brunkhorst FM, Kuhnt E, Engel C et al.; SepNet GCNS (2005) Intensive insulin therapy in patients with severe sepsis and septic shock is associated with an increased rate of hypoglycemia – results from a randomized multicenter study (VISEP). Infection 33: 19–20
9.
Zurück zum Zitat Chang WK, Yang KD, Shaio MF (1999) Lymphocyte proliferation modulated by glutamine: involved in the endogenous redox reaction. Clin Exp Immunol 117: 482–488CrossRefPubMed Chang WK, Yang KD, Shaio MF (1999) Lymphocyte proliferation modulated by glutamine: involved in the endogenous redox reaction. Clin Exp Immunol 117: 482–488CrossRefPubMed
10.
Zurück zum Zitat Dellinger RP, Carlet JM, Masur H et al. (2004) Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 32: 858–873CrossRefPubMed Dellinger RP, Carlet JM, Masur H et al. (2004) Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 32: 858–873CrossRefPubMed
11.
Zurück zum Zitat Faucher M, Bregeon F, Gainnier M, Thirion X, Auffray JP, Papazian L (2003) Cardiopulmonary effects of lipid emulsions in patients with ARDS. Chest 124: 285–291CrossRefPubMed Faucher M, Bregeon F, Gainnier M, Thirion X, Auffray JP, Papazian L (2003) Cardiopulmonary effects of lipid emulsions in patients with ARDS. Chest 124: 285–291CrossRefPubMed
12.
Zurück zum Zitat Gadek JE, DeMichele SJ, Karlstad MD et al. (1999) Effect of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in patients with acute respiratory distress syndrome. Enteral Nutrition in ARDS Study Group. Crit Care Med 27: 1409–1420CrossRefPubMed Gadek JE, DeMichele SJ, Karlstad MD et al. (1999) Effect of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in patients with acute respiratory distress syndrome. Enteral Nutrition in ARDS Study Group. Crit Care Med 27: 1409–1420CrossRefPubMed
13.
Zurück zum Zitat Galban C, Montejo JC, Mesejo A et al. (2000) An immune-enhancing enteral diet reduces mortality rate and episodes of bacteremia in septic intensive care unit patients. Crit Care Med 28: 643–648CrossRefPubMed Galban C, Montejo JC, Mesejo A et al. (2000) An immune-enhancing enteral diet reduces mortality rate and episodes of bacteremia in septic intensive care unit patients. Crit Care Med 28: 643–648CrossRefPubMed
14.
Zurück zum Zitat Garcia-de-Lorenzo A, Denia R, Atlan P, Martinez-Ratero S, Le Brun A, Evard D, Bereziat G (2005) Parenteral nutrition providing a restricted amount of linoleic acid in severely burned patients: a randomised double-blind study of an olive oil-based lipid emulsion v. medium/long-chain triacylglycerols. Br J Nutr 94: 221–230CrossRefPubMed Garcia-de-Lorenzo A, Denia R, Atlan P, Martinez-Ratero S, Le Brun A, Evard D, Bereziat G (2005) Parenteral nutrition providing a restricted amount of linoleic acid in severely burned patients: a randomised double-blind study of an olive oil-based lipid emulsion v. medium/long-chain triacylglycerols. Br J Nutr 94: 221–230CrossRefPubMed
15.
Zurück zum Zitat Goeters C, Wenn A, Mertes N, Wempe C, Van Aken H, Stehle P, Bone HG (2002) Parenteral L-alanyl-L-glutamine improves 6-month outcome in critically ill patients. Crit Care Med 30: 2032–2037CrossRefPubMed Goeters C, Wenn A, Mertes N, Wempe C, Van Aken H, Stehle P, Bone HG (2002) Parenteral L-alanyl-L-glutamine improves 6-month outcome in critically ill patients. Crit Care Med 30: 2032–2037CrossRefPubMed
16.
Zurück zum Zitat Gramlich L, Kichian K, Pinilla J, Rodych NJ, Dhaliwal R, Heyland DK (2004) Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature. Nutrition 20: 843–848CrossRefPubMed Gramlich L, Kichian K, Pinilla J, Rodych NJ, Dhaliwal R, Heyland DK (2004) Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature. Nutrition 20: 843–848CrossRefPubMed
17.
Zurück zum Zitat Griffiths RD, Jones C, Palmer TE (1997) Six-month outcome of critically ill patients given glutamine-supplemented parenteral nutrition. Nutrition 13: 295–302PubMed Griffiths RD, Jones C, Palmer TE (1997) Six-month outcome of critically ill patients given glutamine-supplemented parenteral nutrition. Nutrition 13: 295–302PubMed
18.
Zurück zum Zitat Grimminger F, Mayer K, Kiss L, Walmrath D, Seeger W (2000) PAF-induced synthesis of tetraenoic and pentaenoic leukotrienes in the isolated rabbit lung. Am J Physiol Lung Cell Mol Physiol 278: L268–275PubMed Grimminger F, Mayer K, Kiss L, Walmrath D, Seeger W (2000) PAF-induced synthesis of tetraenoic and pentaenoic leukotrienes in the isolated rabbit lung. Am J Physiol Lung Cell Mol Physiol 278: L268–275PubMed
19.
Zurück zum Zitat Guedon C, Schmitz J, Lerebours E, Metayer J, Audran E, Hemet J, Colin R (1986) Decreased brush border hydrolase activities without gross morphologic changes in human intestinal mucosa after prolonged total parenteral nutrition of adults. Gastroenterology 90: 373–378PubMed Guedon C, Schmitz J, Lerebours E, Metayer J, Audran E, Hemet J, Colin R (1986) Decreased brush border hydrolase activities without gross morphologic changes in human intestinal mucosa after prolonged total parenteral nutrition of adults. Gastroenterology 90: 373–378PubMed
19a.
Zurück zum Zitat Heller AR, Rossler S, Litz RJ, Stehr SN, Heller SC, Koch R, Koch T (2006) Omega-3 fatty acids improve the diagnosis-related clinical outcome. Crit Care Med 34: Epub ahead of print Heller AR, Rossler S, Litz RJ, Stehr SN, Heller SC, Koch R, Koch T (2006) Omega-3 fatty acids improve the diagnosis-related clinical outcome. Crit Care Med 34: Epub ahead of print
20.
Zurück zum Zitat Heyland DK, Dhaliwal R, Drover JW, Gramlich L, Dodek P (2003) Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN J Parenter Enteral Nutr 27: 355–373PubMed Heyland DK, Dhaliwal R, Drover JW, Gramlich L, Dodek P (2003) Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN J Parenter Enteral Nutr 27: 355–373PubMed
21.
Zurück zum Zitat Heyland DK, Novak F, Drover JW, Jain M, Su X, Suchner U (2001) Should immunonutrition become routine in critically ill patients? A systematic review of the evidence. JAMA 286: 944–953CrossRefPubMed Heyland DK, Novak F, Drover JW, Jain M, Su X, Suchner U (2001) Should immunonutrition become routine in critically ill patients? A systematic review of the evidence. JAMA 286: 944–953CrossRefPubMed
22.
Zurück zum Zitat Hotchkiss RS, Karl IE (2003) The pathophysiology and treatment of sepsis. N Engl J Med 348: 138–150CrossRefPubMed Hotchkiss RS, Karl IE (2003) The pathophysiology and treatment of sepsis. N Engl J Med 348: 138–150CrossRefPubMed
23.
Zurück zum Zitat Kieft H, Roos AN, van Drunen JD, Bindels AJ, Bindels JG, Hofman Z (2005) Clinical outcome of immunonutrition in a heterogeneous intensive care population. Intensive Care Med 31: 524–532CrossRefPubMed Kieft H, Roos AN, van Drunen JD, Bindels AJ, Bindels JG, Hofman Z (2005) Clinical outcome of immunonutrition in a heterogeneous intensive care population. Intensive Care Med 31: 524–532CrossRefPubMed
24.
Zurück zum Zitat Kuse ER, Kotzerke J, Muller S, Nashan B, Luck R, Jaeger K (2002) Hepatic reticuloendothelial function during parenteral nutrition including an MCT/LCT or LCT emulsion after liver transplantation – a double-blind study. Transpl Int 15: 272–277CrossRefPubMed Kuse ER, Kotzerke J, Muller S, Nashan B, Luck R, Jaeger K (2002) Hepatic reticuloendothelial function during parenteral nutrition including an MCT/LCT or LCT emulsion after liver transplantation – a double-blind study. Transpl Int 15: 272–277CrossRefPubMed
25.
Zurück zum Zitat Lacey JM, Wilmore DW (1990) Is glutamine a conditionally essential amino acid? Nutr Rev 48: 297–309PubMed Lacey JM, Wilmore DW (1990) Is glutamine a conditionally essential amino acid? Nutr Rev 48: 297–309PubMed
26.
Zurück zum Zitat Langouche L, Vanhorebeek I, Vlasselaers D et al. (2005) Intensive insulin therapy protects the endothelium of critically ill patients. J Clin Invest 115: 2277–2286CrossRefPubMed Langouche L, Vanhorebeek I, Vlasselaers D et al. (2005) Intensive insulin therapy protects the endothelium of critically ill patients. J Clin Invest 115: 2277–2286CrossRefPubMed
27.
Zurück zum Zitat Lewis SJ, Egger M, Sylvester PA, Thomas S (2001) Early enteral feeding versus „nil by mouth“ after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. BMJ 323: 773–776CrossRefPubMed Lewis SJ, Egger M, Sylvester PA, Thomas S (2001) Early enteral feeding versus „nil by mouth“ after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. BMJ 323: 773–776CrossRefPubMed
28.
Zurück zum Zitat Mayer K, Fegbeutel C, Hattar K et al. (2003) Omega-3 vs. omega-6 lipid emulsions exert differential influence on neutrophils in septic shock patients: impact on plasma fatty acids and lipid mediator generation. Intensive Care Med 29: 1472–1481CrossRefPubMed Mayer K, Fegbeutel C, Hattar K et al. (2003) Omega-3 vs. omega-6 lipid emulsions exert differential influence on neutrophils in septic shock patients: impact on plasma fatty acids and lipid mediator generation. Intensive Care Med 29: 1472–1481CrossRefPubMed
29.
Zurück zum Zitat Mayer K, Gokorsch S, Fegbeutel C et al. (2003) Parenteral nutrition with fish oil modulates cytokine response in patients with sepsis. Am J Respir Crit Care Med 167: 1321–1328CrossRefPubMed Mayer K, Gokorsch S, Fegbeutel C et al. (2003) Parenteral nutrition with fish oil modulates cytokine response in patients with sepsis. Am J Respir Crit Care Med 167: 1321–1328CrossRefPubMed
30.
Zurück zum Zitat Mentec H, Dupont H, Bocchetti M, Cani P, Ponche F, Bleichner G (2001) Upper digestive intolerance during enteral nutrition in critically ill patients: frequency, risk factors, and complications. Crit Care Med 29: 1955–1961CrossRefPubMed Mentec H, Dupont H, Bocchetti M, Cani P, Ponche F, Bleichner G (2001) Upper digestive intolerance during enteral nutrition in critically ill patients: frequency, risk factors, and complications. Crit Care Med 29: 1955–1961CrossRefPubMed
31.
Zurück zum Zitat Mesotten D, Delhanty PJ, Vanderhoydonc F, Hardman KV, Weekers F, Baxter RC, Van Den Berghe G (2002) Regulation of insulin-like growth factor binding protein-1 during protracted critical illness. J Clin Endocrinol Metab 87: 5516–5523CrossRefPubMed Mesotten D, Delhanty PJ, Vanderhoydonc F, Hardman KV, Weekers F, Baxter RC, Van Den Berghe G (2002) Regulation of insulin-like growth factor binding protein-1 during protracted critical illness. J Clin Endocrinol Metab 87: 5516–5523CrossRefPubMed
32.
Zurück zum Zitat Peterson J, Bihain BE, Bengtsson-Olivecrona G, Deckelbaum RJ, Carpentier YA, Olivecrona T (1990) Fatty acid control of lipoprotein lipase: a link between energy metabolism and lipid transport. Proc Natl Acad Sci USA 87: 909–913PubMed Peterson J, Bihain BE, Bengtsson-Olivecrona G, Deckelbaum RJ, Carpentier YA, Olivecrona T (1990) Fatty acid control of lipoprotein lipase: a link between energy metabolism and lipid transport. Proc Natl Acad Sci USA 87: 909–913PubMed
33.
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
34.
Zurück zum Zitat Samra JS, Simpson EJ, Clark ML, Forster CD, Humphreys SM, Macdonald IA, Frayn KN (1996) Effects of epinephrine infusion on adipose tissue: interactions between blood flow and lipid metabolism. Am J Physiol 271: E834–839PubMed Samra JS, Simpson EJ, Clark ML, Forster CD, Humphreys SM, Macdonald IA, Frayn KN (1996) Effects of epinephrine infusion on adipose tissue: interactions between blood flow and lipid metabolism. Am J Physiol 271: E834–839PubMed
35.
Zurück zum Zitat Serhan CN, Gotlinger K, Hong S, Arita M (2004) Resolvins, docosatrienes, and neuroprotectins, novel omega-3-derived mediators, and their aspirin-triggered endogenous epimers: an overview of their protective roles in catabasis. Prostaglandins Other Lipid Mediat 73: 155–172CrossRefPubMed Serhan CN, Gotlinger K, Hong S, Arita M (2004) Resolvins, docosatrienes, and neuroprotectins, novel omega-3-derived mediators, and their aspirin-triggered endogenous epimers: an overview of their protective roles in catabasis. Prostaglandins Other Lipid Mediat 73: 155–172CrossRefPubMed
36.
Zurück zum Zitat Steinberg J, Halter J, Schiller H, Gatto L, Nieman G (2005) The development of acute respiratory distress syndrome after gut ischemia/reperfusion injury followed by fecal peritonitis in pigs: a clinically relevant model. Shock 23: 129–137CrossRefPubMed Steinberg J, Halter J, Schiller H, Gatto L, Nieman G (2005) The development of acute respiratory distress syndrome after gut ischemia/reperfusion injury followed by fecal peritonitis in pigs: a clinically relevant model. Shock 23: 129–137CrossRefPubMed
37.
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: 32–35PubMed 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: 32–35PubMed
38.
Zurück zum Zitat van Acker BA, von Meyenfeldt MF, van der Hulst RR et al. (1999) Glutamine: the pivot of our nitrogen economy? JPEN J Parenter Enteral Nutr 23: S45–48PubMed van Acker BA, von Meyenfeldt MF, van der Hulst RR et al. (1999) Glutamine: the pivot of our nitrogen economy? JPEN J Parenter Enteral Nutr 23: S45–48PubMed
39.
Zurück zum Zitat van den Berghe G, Wouters P, Weekers F et al. (2001) Intensive insulin therapy in the critically ill patients. N Engl J Med 345: 1359–1367CrossRefPubMed van den Berghe G, Wouters P, Weekers F et al. (2001) Intensive insulin therapy in the critically ill patients. N Engl J Med 345: 1359–1367CrossRefPubMed
40.
Zurück zum Zitat Vanhorebeek I, De Vos R, Mesotten D, Wouters PJ, De Wolf-Peeters C, Van den Berghe G (2005) Protection of hepatocyte mitochondrial ultrastructure and function by strict blood glucose control with insulin in critically ill patients. Lancet 365: 53–59CrossRefPubMed Vanhorebeek I, De Vos R, Mesotten D, Wouters PJ, De Wolf-Peeters C, Van den Berghe G (2005) Protection of hepatocyte mitochondrial ultrastructure and function by strict blood glucose control with insulin in critically ill patients. Lancet 365: 53–59CrossRefPubMed
41.
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: 502–509CrossRefPubMed 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: 502–509CrossRefPubMed
42.
Zurück zum Zitat Weimann A, Jauch KW, Kemen M, Hiesmayr JM, Horbach T, Kuse ER, Vestweber KH (2003) DGEM-Leitlinie Enterale Ernährung: Chirurgie und Transplantation. Akt Ernaehr Med 28: S51-S68CrossRef Weimann A, Jauch KW, Kemen M, Hiesmayr JM, Horbach T, Kuse ER, Vestweber KH (2003) DGEM-Leitlinie Enterale Ernährung: Chirurgie und Transplantation. Akt Ernaehr Med 28: S51-S68CrossRef
43.
Zurück zum Zitat Weissman C (1990) The metabolic response to stress: an overview and update. Anesthesiology 73: 308–327PubMed Weissman C (1990) The metabolic response to stress: an overview and update. Anesthesiology 73: 308–327PubMed
44.
Zurück zum Zitat Wichmann W, Morilion B, Czarnetzki H-D, Thul P, Jauch KW (2004) Reduction of length of postoperative hospital stay by fish oil containing lipid emulsion – data from a multicenter trial. Clin Nutr 23: 1271 Wichmann W, Morilion B, Czarnetzki H-D, Thul P, Jauch KW (2004) Reduction of length of postoperative hospital stay by fish oil containing lipid emulsion – data from a multicenter trial. Clin Nutr 23: 1271
45.
Zurück zum Zitat Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A (1997) Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg 63: 356–361CrossRefPubMed Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A (1997) Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg 63: 356–361CrossRefPubMed
46.
Zurück zum Zitat Ziegler TR, Young LS, Benfell K et al. (1992) Clinical and metabolic efficacy of glutamine-supplemented parenteral nutrition after bone marrow transplantation. A randomized, double-blind, controlled study. Ann Intern Med 116: 821–828PubMed Ziegler TR, Young LS, Benfell K et al. (1992) Clinical and metabolic efficacy of glutamine-supplemented parenteral nutrition after bone marrow transplantation. A randomized, double-blind, controlled study. Ann Intern Med 116: 821–828PubMed
47.
Zurück zum Zitat van den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, von Wijngaerden E, Bobbaers H, Bouillon R (2006) Intensive insulin therapy in the medical ICU. N Engl J Med 354: 449CrossRefPubMed van den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, von Wijngaerden E, Bobbaers H, Bouillon R (2006) Intensive insulin therapy in the medical ICU. N Engl J Med 354: 449CrossRefPubMed
Metadaten
Titel
Ernährung und Immunonutrition bei Sepsis
verfasst von
Dr. K. Mayer
M. B. Schaefer
H. D. Walmrath
F. Grimminger
W. Seeger
Publikationsdatum
01.04.2006
Verlag
Springer-Verlag
Erschienen in
Die Innere Medizin / Ausgabe 4/2006
Print ISSN: 2731-7080
Elektronische ISSN: 2731-7099
DOI
https://doi.org/10.1007/s00108-006-1592-0

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