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Review
. 2009 Nov 18:7:Doc14.
doi: 10.3205/000073.

Intensive medicine - Guidelines on Parenteral Nutrition, Chapter 14

G Kreymann  1 , M Adolph, W Druml, K W Jauch; Working group for developing the guidelines for parenteral nutrition of The German Association for Nutritional Medicine
Collaborators, Affiliations
Review

Intensive medicine - Guidelines on Parenteral Nutrition, Chapter 14

G Kreymann et al. Ger Med Sci. .

Abstract
in English, German

In intensive care patients parenteral nutrition (PN) should not be carried out when adequate oral or enteral nutrition is possible. Critically ill patients without symptoms of malnutrition, who probably cannot be adequately nourished enterally for a period of <5 days, do not require full PN but should be given at least a basal supply of glucose. Critically ill patients should be nourished parenterally from the beginning of intensive care if they are unlikely to be adequately nourished orally or enterally even after 5-7 days. Critically ill and malnourished patients should, in addition to a possible partial enteral nutrition, be nourished parenterally. Energy supply should not be constant, but should be adapted to the stage, the disease has reached. Hyperalimentation should be avoided at an acute stage of disease in any case. Critically ill patients should be given, as PN, a mixture consisting of amino acids (between 0.8 and 1.5 g/kg/day), carbohydrates (around 60% of the non-protein energy) and fat (around 40% of the non-protein energy) as well as electrolytes and micronutrients.

Eine parenterale Ernährung (PE) sollte nicht durchgeführt werden, wenn eine ausreichende orale oder enterale Ernährung möglich ist. Kritisch Kranke ohne Zeichen der Mangelernährung, die voraussichtlich <5 Tage nicht ausreichend enteral ernährt werden können, bedürfen keiner vollen PE, sollten aber zumindest eine basale Glukosezufuhr erhalten. Kritisch Kranke sollten von Anbeginn der Intensivtherapie parenteral ernährt werden, wenn sie voraussichtlich auch nach einem Zeitraum von 5–7 Tagen nicht ausreichend oral oder enteral ernährt werden können. Kritisch Kranke mit einer Mangelernährung sollten – auch neben einer möglichen partiellen enteralen Ernährung – parenteral ernährt werden. Die Energiezufuhr sollte nicht konstant sein, sondern muss an den Verlauf der Erkrankung angepasst werden. Eine Hyperalimentation sollte im akuten Stadium der Erkrankung auf jeden Fall vermieden werden. Kritisch Kranke sollten zur PE eine Mischung aus Aminosäuren (0,8 und 1,5 g/kg/Tag), Kohlenhydraten (ca. 60% der Nicht-Protein Energie) und Fett (ca. 40% der Nicht-Protein Energie) sowie Elektrolyten und Mikronährstoffen erhalten.

Keywords: critically ill; intensive care; sepsis; substrate supply.

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References

    1. Braunschweig CL, Levy P, Sheean PM, Wang X. Enteral compared with parenteral nutrition: a meta-analysis. Am J Clin Nutr. 2001;74(4):534–542. - PubMed
    1. Bertolini G, Iapichino G, Radrizzani D, Facchini R, Simini B, Bruzzone P, Zanforlin G, Tognoni G. Early enteral immunonutrition in patients with severe sepsis: results of an interim analysis of a randomized multicentre clinical trial. Intensive Care Med. 2003;29(5):834–840. - PubMed
    1. Woodcock NP, Zeigler D, Palmer MD, Buckley P, Mitchell CJ, MacFie J. Enteral versus parenteral nutrition: a pragmatic study. Nutrition. 2001;17(1):1–12. doi: 10.1016/S0899-9007(00)00576-1. Available from: http://dx.doi.org/10.1016/S0899-9007(00)00576-1. - DOI - DOI - PubMed
    1. Sandström R, Drott C, Hyltander A, Arfvidsson B, Scherstén T, Wickström I, Lundholm K. The effect of postoperative intravenous feeding (TPN) on outcome following major surgery evaluated in a randomized study. Ann Surg. 1993;217(2):185–195. - PMC - PubMed
    1. Tappy L, Schwarz JM, Schneiter P, Cayeux C, Revelly JP, Fagerquist CK, Jéquier E, Chioléro R. Effects of isoenergetic glucose-based or lipid-based parenteral nutrition on glucose metabolism, de novo lipogenesis, and respiratory gas exchanges in critically ill patients. Crit Care Med. 1998;26(5):860–867. doi: 10.1097/00003246-199805000-00018. Available from: http://dx.doi.org/10.1097/00003246-199805000-00018. - DOI - DOI - PubMed

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