Zusammenfassung
Der präoperative Ernährungsstatus und die perioperative Ernährungsstrategie spielen
eine wichtige Rolle für das Outcome herzchirurgischer Patienten – dennoch gibt es
nur wenige Studien zu Ernährungskonzepten für diese Patientengruppe. In diesem Beitrag
werden die Ursachen der Mangelernährung, der Einfluss der Ernährungstherapie auf den
herzchirurgischen Patienten und Strategien zur Verbesserung der Ernährung beschrieben.
Abstract
Cardiac surgery patients regularly experience a systemic inflammation response to
the surgery and a postoperative stay in the intensive care unit. Nutritional support
is one strategy to improve the outcome of cardiosurgical patients. A preoperatively
diagnosed malnutrition contributes to a higher morbidity and mortality in this patient
group. Preoperative fasting, glucose-free infusions during long and invasive operations
and delayed postoperative nutrition therapy aggravate the nutrition situation. However,
conclusive evidence for this population, consisting of well-conducted clinical trials
is lacking.
This article outlines the main causes for malnutrition in cardiosurgical patients
and summarizes possibilities to identify patients at high nutritional risk, who are
most likely to profit from aggressive nutritional therapy. Despite conspicuous knowledge
and evidence gaps, a rational nutritional support therapy based on current recommendations
of ASPEN, ESPEN and an international multidisciplinary consensus group is presented.
The amount and kind of nutrition, as well as the best time to initiate nutrition support,
ways to monitor nutrition therapy and the potential use of pharmaconutrition to modulate
the inflammatory response to cardiopulmonary bypass are presented to benefit patients
undergoing cardiac surgery.
Schlüsselwörter
Herzchirurgie - Ernährung - Pharmakonutrition - Malnutrition - Outcome
Key words
cardiac surgery, nutrition, pharmaconutrition, malnutrition, outcome
