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DOI: 10.1055/s-2008-1027281
© Georg Thieme Verlag KG Stuttgart · New York
Implementierung evidenzbasierter Leitlinien zum Ernährungssupport auf der Intensivstation
Publication History
Publication Date:
02 April 2008 (online)

Zusammenfassung
Der Ernährungssupport gehört zur Standardbehandlung auf der Intensivstation. In den letzten Jahren wurden verschiedene Leitlinien für den Ernährungssupport auf Intensivstationen erstellt und publiziert. Um das Wissen in die Praxis zu transferieren, damit Patienten und Gesundheitswesen rasch davon profitieren können, braucht es Strategien. Eine Möglichkeit, Leitlinien in die Praxis umzusetzen, ist die Erstellung von Handlungsanleitungen oder Algorithmen. Diese haben nicht nur zum Ziel, evidenzbasierte Erkenntnisse patientenzentriert in der Praxis anzuwenden, sondern sollen auch zu einem standardisierten Vorgehen führen. Die Entwicklung und Implementierung einer Handlungsanweisung für den Ernährungssupport erfordert die multiprofessionelle Zusammenarbeit von Ärzten, Pflegefachpersonen und Ernährungsspezialisten. Verschiedene Studien konnten zeigen, dass Intensivstationen, die sich nach Leitlinien richteten, sowohl eine Verbesserung des Ernährungssupports als auch der Patientenbehandlung erreichten.
Literatur
- 1
Lochs H, Allison S P, Meier R. et al .
Introductory to the ESPEN guidelines on enteral nutrition: Terminology, definitions
and general topics.
Clin Nutr.
2006;
25
180-186
, http: //www.espen.org/Education/documents/ENGeneral.pdf; Zugriff 1.2.2008
Reference Ris Wihthout Link
- 2
Berger M M, Chioléro R L.
Hypocaloric feedings: pros and cons.
Curr Opin Crit Care.
2007;
13
180-186
Reference Ris Wihthout Link
- 3
Fulbrook P.
A European survey of enteral nutrition practices and procedures in adult intensive
care units.
J Clin Nurs.
2007;
16
2132-2141
Reference Ris Wihthout Link
- 4
Preiser J C, Berré J, Carpentier Y. et al .
Management of nutrition in European intensive care units: results of a questionnaire.
Intens Care Med.
1999;
25
95-101
Reference Ris Wihthout Link
- 5
De Jonghe B, Appere-De-Vechi C, Fournier M. et al .
A prospective survey of nutritional support practices in intensive care unit patients:
What is prescribed? What is delivered?.
Crit Care Med.
2001;
29
8-12
Reference Ris Wihthout Link
- 6
Heyland D K, Schroter-Noppe D, Drover J W. et al .
Nutrition support in the critical care setting: Current practice in Canadian ICUs
- opportunities for improvement?.
J Parent Enteral Nutr.
2003;
27
74-83
Reference Ris Wihthout Link
- 7
Wenzel Persenius M, Wilde Larson B, Hall-Lord M L.
Enteral nutrition in intensive care - Nurses’ perceptions and bedside observations.
Intens Crit Care Nurs.
2006;
22
82-94
Reference Ris Wihthout Link
- 8
Petros S, Engelmann L.
Enteral nutrition delivery and energy expenditure in medical intensive care patients.
Clin Nutr.
2006;
25
51-59
Reference Ris Wihthout Link
- 9
Hearnshaw S A, Thompson N P.
Use of parenteral nutrition in hospitals in the North of England.
J Hum Nutr Diet.
2007;
20
14-23
Reference Ris Wihthout Link
- 10
Windle E M.
Adequacy of dietetic service provision to adult critical care: a survey of 33 centres
in Northern England.
J Hum Nutr Diet.
2007;
20
111-120
Reference Ris Wihthout Link
- 11
Beck A M, Balkn U N, Fürst P. et al .
Food and nutritional care in hospitals. How to prevent undernutrition - report and
guidelines from the Council of Europe.
Clin Nutr.
2001;
20
455-460
Reference Ris Wihthout Link
- 12
Heyland D K, Dhaliwal R, Drover J. et al .
Canadian clinical practice guidelines for nutrition support in mechanically ventilated,
critically ill adult patients. Update 2005: Dhaliwal R, Heyland DK Curr Opin Crit
Care 2005; 11: 461-467.
JPEN.
2003;
27
355-373
, Update 2007: http: //www.criticalcarenutrition.com/docs/pubs/cpgpublished.pdf; Zugriff
1.02.2008
Reference Ris Wihthout Link
- 13
Jacobs D G, Jacobs D O, Kudsk K A. et al .
Practice management guidelines for nutritional support of the trauma patient.
J Trauma.
2004;
57
66-679
Reference Ris Wihthout Link
- 14 Doig G S, Simpson F. the Australian and New Zealand Intensive Care Society Clinical Trials Group .Evidence-based guidelines for nutritional support of the critically ill: Results of
a bi-national guideline development conference. Carlton; Australian and New Zealand Intensive Care Society 2005 http://www.evidencebased.net/files/EBGforNutSupportofICUpts.pdf; Zugriff 1.2.2008
Reference Ris Wihthout Link
- 15
Weimann A, Braga M, Harsanyi L. et al .
ESPEN Guidelines on enteral nutrition: Surgery including organ transplantation.
Clin Nutr.
2006;
25
224-244
, http: //www.espen.org/Education/documents/ENSurgery.pdf; Zugriff 1.2.2008
Reference Ris Wihthout Link
- 16
Kreymann K G, Berger M M, Deutz N E. et al .
ESPEN guidelines on enteral nutrition: Intensive care.
Clin Nutr.
2006;
25
210-223
, http://www.espen.org/Education/documents/ENICU.pdf; Zugriff 1.5.2007
Reference Ris Wihthout Link
- 17
Kreymann G, Ebner C, Hartl W. et al .
DGEM-Leitlinie Enerale Ernährung: Intensivmedizin.
Aktuel Ernaehr Med.
2003;
28
S42-50
Reference Ris Wihthout Link
- 18
Forbes A.
Global guidelines for nutrition support (letter).
Lancet.
2007;
370
1906
Reference Ris Wihthout Link
- 19
Evidenzbasierte Medizin. Das Deutsche Cochrane Zentrum.
, http://www.cochrane.de/de/ebhc.htm; Zugriff 23.1.2008
Reference Ris Wihthout Link
- 20
Biolo G, Grimble G, Preiser J C. et al .
Position paper of the ESICM working group on nutrition and metabolism.
Intens Care Med.
2002;
28
1512-1520
Reference Ris Wihthout Link
- 21
Scheppach W, Suchner U, Keymling M.
Künstliche Ernährung des kritisch kranken Patienten - eine Diskussion der kanadischen
Leitlinien.
Aktuel Ernaehr Med.
2005;
30
117-123
Reference Ris Wihthout Link
- 22
Bistrian B R, McCowen K C.
Nutritional and metabolic support in the adult intensive care unit: key controversies.
Crit Care Med.
2006;
34
1525-1531
Reference Ris Wihthout Link
- 23
Wernermann J.
Guidelines for nutritional support in intensive care unit patients: a critical analysis.
Curr Opin Clin Nutr Metab Care.
2005;
8
171-175
Reference Ris Wihthout Link
- 24
Dhaliwal R, Jurewitsch B, Harrietha D. et al .
Combination enteral and parenteral nutrition in critically ill patients: harmful or
beneficial? A systematic review of the evidence.
Intens Care Med.
2004;
30
1666-1671
Reference Ris Wihthout Link
- 25
Heyland D K, Novak F, Drover J. et al .
Should immunonutrition become routine in critically ill patients? A systematic review
of the evidence.
JAMA.
2001;
286
944-953
Reference Ris Wihthout Link
- 26
Krishnan J A, Parce P B, Martinez A. et al .
Caloric intake in medical ICU patients: Consistency of care with guidelines and relationship
to clinical outcomes.
Chest.
2003;
124
297-305
Reference Ris Wihthout Link
- 27
Berger M M, Chioéro R E, Pannatier A. et al .
A 10-year survey of nutritional support in a surgical ICU: 1986-1995.
Nutrition.
1997;
13
870-877
Reference Ris Wihthout Link
- 28
Doig G S, Simpson F.
Early enteral nutrition in the critically ill: do we need more evidence or better
evidence?.
Curr Opin Crit Care.
2006;
12
126-130
Reference Ris Wihthout Link
- 29
Doig G S, Simpson F, Delaney A.
A review of the true methodological quality of nutritional support trials conducted
in the critically ill: Time for improvement.
Anesth Analg.
2005;
100
527-533
Reference Ris Wihthout Link
- 30
Weingarten S.
Translating practice guidelines into patient care.
Chest.
2000;
118
S4-S7
Reference Ris Wihthout Link
- 31
Heffner J E, Alberts W M, Irwin R. et al .
Translating guidelines into clinical practice.
Chest.
2000;
118
S70-S73
Reference Ris Wihthout Link
- 32
Davis D A, Taylor-Vaisey A.
Translating guidelines into practice.
CMAJ.
1997;
157
408-416
Reference Ris Wihthout Link
- 33
Smith W R.
Evidence for the effectiveness of techniques to change physician behaviour.
Chest.
2000;
118
S8-S17
Reference Ris Wihthout Link
- 34
Davis D, Evans M, Jadad A. et al .
The case for knowledge translation: shortening the journey from evidence to effect.
BMJ.
2003;
327
33-35
Reference Ris Wihthout Link
- 35
Blackwood B, Wilson-Barnett J.
The impact of nurse-directed protocolised-weaning from mechanical ventilation on nursing
practice: A quasi-experimental study.
Int J Nurs Stud.
2007;
44
209-226
Reference Ris Wihthout Link
- 36
Taylor B E, Schallom M E, Sona C S. et al .
Efficacy and safety of an insulin infusion protocol in a surgical ICU.
J Am Coll Surg.
2006;
202
1-9
Reference Ris Wihthout Link
- 37
Meijering S, Corstjens A M, Tulleken J E. et al .
Towards a feasible algorithm for tight glycaemic control in critically ill patients:
a systematic review of the literature.
Crit Care.
2006;
10
R19
DOI: 10.1186 /cc3981
Reference Ris Wihthout Link
- 38
Grap M J, Strickland D, Tormey l. et al .
Collaborative practice: Development, implementation, and evaluation of a weaning protocol
for patients receiving mechanical ventilation.
Am J Crit Care.
2003;
12
454-460
Reference Ris Wihthout Link
- 39
Berger M M, Revelly J P, Wasserfallen J B. et al .
Impact of a computerized information system on quality of nutritional support in the
ICU.
Nutrition.
2006;
22
221-229
Reference Ris Wihthout Link
- 40
Plost G, Nelson D P.
Empowering critical care nurses to improve compliance with protocols in the intensive
care unit.
Am J Crit Care.
2007;
16
153-157
Reference Ris Wihthout Link
- 41
Sinuff T, Cook D, Giacomini M. et al .
Facilitating clinican adherence to guidelines in the intensive care unit: A multicenter,
qualitative study.
Crit Care Med.
2007;
35
2083-2089
Reference Ris Wihthout Link
- 42
Jones N E, Suurdt J, Ouelette-Kuntz H. et al .
Implementation of the Canadian clinical practice guidelines for nutrition support:
A multiple case study of barriers and enablers.
Nutr Clin Pract.
2007;
22
449-457
Reference Ris Wihthout Link
- 43
Weiss K B, Wagner R.
Performance measurement through audit, feedback, and profiling as tools for improving
clinical care.
Chest.
2000;
118
S53-S58
Reference Ris Wihthout Link
- 44 Skates J, Harvey-Banchik L. Quality improvement. Gottschlich MM Nutrition Support Core Curriculum Aspen; Silver Spring 2007: 761-782
Reference Ris Wihthout Link
- 45
Heyland D K, Dhaliwal R, Day A. et al .
Validation of the Canadian clinical practice guidelines for nutrition support in mechanically
ventilated, critically ill adult patients: Results of a prospective observational
study.
Crit Care Med.
2004;
32
2260-2266
Reference Ris Wihthout Link
- 46
Kozar R A, McQuiggan M M, Moore E E. et al .
Postinjury enteral tolerance is reliably achieved by a standardized protocol.
J Surg Res.
2002;
104
70-75
Reference Ris Wihthout Link
- 47
Rice T W, Swope T, Bozeman S. et al .
Variation in enteral nutrition delivery in mechanically ventilated patients.
Nutrition.
2005;
21
786-792
Reference Ris Wihthout Link
- 48
Woien H, Torunn Bjork I.
Nutrition of the critically ill patient and effects of implementing a nutritional
support algorithm in ICU.
J Clin Nurs.
2006;
15
168-177
Reference Ris Wihthout Link
- 49
Jain M K, Heyland D, Dhaliwal R. et al .
Dissemination of the Canadian clinical practice guidelines for nutrition support:
Results of a cluster randomized controlled trial.
Crit Care Med.
2006;
34
2362-2369
Reference Ris Wihthout Link
- 50
Martin C M, Doig G S, Heyland D K. et al .
Multicentre, cluster-randomized clinical trial of algorithms for critical-care enteral
and parenteral therapy (ACCEPT).
CMAJ.
2004;
170
197-204
Reference Ris Wihthout Link
- 51
Barr J, Hecht M, Flavin K E. et al .
Outcomes in critically ill patients before and after the implementation of an evidence-based
nutritional management protocol.
Chest.
2004;
125
1446-1457
Reference Ris Wihthout Link
Caroline M. Weberhofer
Ernährungsberatung, Klinik für Endokrinologie, Diabetologie und klinische Ernährung,
Universitätsspital Basel
Spitalstr. 26
4031 Basel, Schweiz
Phone: ++ 41/61/2 65 25 25
Email: cweberhofer@uhbs.ch