Download PDF
Aktuelle Ernährungsmedizin 2012; 37(1): 36-57
DOI: 10.1055/s-0031-1277004
CME-Fortbildung
© Georg Thieme Verlag KG Stuttgart · New York

Ernährung von Intensivpatienten

Nutrition of the Critically IllT.  W.  Felbinger1 , H.  P.  Richter1
  • 1Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Klinikum Neuperlach, Städtisches Klinikum München GmbH
Further Information

Publication History

Publication Date:
14 February 2012 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Mangelernährung ist ein häufiges und outcomerelevantes Problem auf der Intensivstation. Bei kritisch Kranken verschlechtert sich der Ernährungszustand bei vielen Patienten als Konsequenz des Stressstoffwechsels und einer inadäquaten Substratzufuhr weiter. Die klinische, an den Stoffwechsel des kritisch Kranken adaptierte Ernährung ist die einzige spezifische Therapie einer manifesten oder drohenden Mangelernährung. Dabei muss der Fokus darauf liegen, eine Hyperalimentation in der Frühphase und eine Hypoalimentation in der prolongierten Phase des Intensivaufenthalts zu vermeiden. Zusätzlich werden Omega-3-Fettsäuren und Antioxidanzien auf enteralem Weg bei ARDS (Adult Respiratory Distress Syndrome) empfohlen. Bei Indikation zu einer parenteralen Ernährung soll parenterales Glutamin hoch dosiert verabreicht werden.

Abstract

Malnutrition occurs frequently in the ICU influencing clinical outcome in critically ill patients. As a consequence of stress metabolism and inadequate intake, nutritional status deteriorates in most critically ill patients during their ICU stay. Artificial nutritional support is the only specific therapy to overcome the metabolic consequences of malnutrition. In critically ill patients priority must be given to avoid hyperalimentation in the early phase and hypoalimentation in the prolonged phase of an ICU stay. In ARDS patients, supplementation of enteral diet enriched with omega-3-fatty acids and antioxidants improved outcome. Whenever parenteral nutrition is indicated, high dose parenteral glutamine supplementation should be applied.

Schlüsselwörter

Ernährung - enteral - parenteral - Immunmodulation

Keywords

nutrition - enteral - parenteral - immunomodulation

Literatur

  • 1 Löser C. Unter- / Mangelernährung im Krankenhaus.  Aktuel Ernahrungsmed. 2011;  36 57-77
    Google Scholar
  • 2 McWhirter J P, Pennington C R. Incidence and recognition of malnutrition in hospital.  BMJ. 1994;  308 945-948
    Google Scholar
  • 3 Stratton R, Green C, Elia M. Disease-related malnutrition: an evidence-based approach to treatment. Oxon: CABI Publishing; 2003
    Google Scholar
  • 4 Kondrup J, Rasmussen H H, Hamberg O et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials.  Clin Nutr. 2003;  22 321-336
    Google Scholar
  • 5 Hill G L, Blackett R L, Pickford I et al. Malnutrition in surgical patients. An unrecognised problem.  Lancet. 1977;  1 689-692
    Google Scholar
  • 6 Lennard-Jones J E, Arrowsmith H, Davison C et al. Screening by nurses and junior doctors to detect malnutrition when patients are first assessed in hospital.  Clin Nutr. 1995;  14 336-340
    Google Scholar
  • 7 Pirlich M, Schutz T, Norman K et al. The German hospital malnutrition study.  Clin Nutr. 2006;  25 563-572
    Google Scholar
  • 8 Giner M, Laviano A, Meguid M M et al. In 1995 a correlation between malnutrition and poor outcome in critically ill patients still exists.  Nutrition. 1996;  12 23-29
    Google Scholar
  • 9 Sorensen J, Kondrup J, Prokopowicz J et al. EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome.  Clin Nutr. 2008;  27 340-349
    Google Scholar
  • 10 Lenz A, Franklin G A, Cheadle W G. Systemic inflammation after trauma.  Injury. 2007;  38 1336-1345
    Google Scholar
  • 11 Bone R C. Sir Isaac Newton, sepsis, SIRS, and CARS.  Crit Care Med. 1996;  24 1125-1128
    Google Scholar
  • 12 Black P R, Brooks D C, Bessey P Q et al. Mechanisms of insulin resistance following injury.  Ann Surg. 1982;  196 420-435
    Google Scholar
  • 13 Randle P J, Garland P B, Hales C N et al. The glucose fatty-acid cycle. Its role in insulin sensitivity and the metabolic disturbances of diabetes mellitus.  Lancet. 1963;  1 785-789
    Google Scholar
  • 14 Askanazi J, Elwyn D H, Silverberg P A et al. Respiratory distress secondary to a high carbohydrate load: a case report.  Surgery. 1980;  87 596-598
    Google Scholar
  • 15 Stoner H B, Little R A, Frayn K N et al. The effect of sepsis on the oxidation of carbohydrate and fat.  Br J Surg. 1983;  70 32-35
    Google Scholar
  • 16 Nordenstrom J, Carpentier Y A, Askanazi J et al. Metabolic utilization of intravenous fat emulsion during total parenteral nutrition.  Ann Surg. 1982;  196 221-231
    Google Scholar
  • 17 Singer P, Berger M M, van den Berghe G et al. ESPEN Guidelines on Parenteral Nutrition: intensive care.  Clin Nutr. 2009;  28 387-400
    Google Scholar
  • 18 Elia M. The effects of nitrogen and energy intake on the metabolism of normal, depleted and injured man: considerations for practical nutritional support.  Clin Nutr. 1982;  1 173-192
    Google Scholar
  • 19 Felbinger T W, Suchner U. Ernährungsstrategien bei kritisch kranken Patienten.  Anaesthesie & Intensivmedizin. 2000;  41 206-222
    Google Scholar
  • 20 Loser C. Malnutrition in the hospital--prevalence, clinical consequences, economic relevance.  Dtsch Med Wochenschr. 2001;  126 729-734
    Google Scholar
  • 21 Akinnusi M E, Pineda L A, El Solh A A. Effect of obesity on intensive care morbidity and mortality: a meta-analysis.  Crit Care Med. 2008;  36 151-158
    Google Scholar
  • 22 Correia M I, Waitzberg D L. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis.  Clin Nutr. 2003;  22 235-239
    Google Scholar
  • 23 Memtsoudis S G, Bombardieri A M, Ma Y et al. Mortality of Patients With Respiratory Insufficiency and Adult Respiratory Distress Syndrome After Surgery: The Obesity Paradox.  J Intensive Care Med. 2011;  (ahead of print)
    Google Scholar
  • 24 Atalay B G, Yagmur C, Nursal T Z et al. Use of subjective global assessment and clinical outcomes in critically ill geriatric patients receiving nutrition support.  JPEN J Parenter Enteral Nutr. 2008;  32 454-459
    Google Scholar
  • 25 Gamrin L, Essen P, Hultman E et al. Protein-sparing effect in skeletal muscle of growth hormone treatment in critically ill patients.  Ann Surg. 2000;  231 577-586
    Google Scholar
  • 26 Felbinger T W, Suchner U, Goetz A E et al. Recombinant human growth hormone for reconditioning of respiratory muscle after lung volume reduction surgery.  Crit Care Med. 1999;  27 1634-1638
    Google Scholar
  • 27 Pichard C, Kyle U G, Jolliet P et al. Treatment of cachexia with recombinant growth hormone in a patient before lung transplantation: a case report.  Crit Care Med. 1999;  27 1639-1642
    Google Scholar
  • 28 Takala J, Ruokonen E, Webster N R et al. Increased mortality associated with growth hormone treatment in critically ill adults.  N Engl J Med. 1999;  341 785-792
    Google Scholar
  • 29 Dudrick S J, Wilmore D W, Vars H M et al. Long-term total parenteral nutrition with growth, development, and positive nitrogen balance. 1968.  Nutr Hosp. 2001;  16 287-292; discussion 286–287
    Google Scholar
  • 30 Burke J F, Wolfe R R, Mullany C J et al. Glucose requirements following burn injury. Parameters of optimal glucose infusion and possible hepatic and respiratory abnormalities following excessive glucose intake.  Ann Surg. 1979;  190 274-285
    Google Scholar
  • 31 Garrel D R, Jobin N, de Jonge L H. Should we still use the Harris and Benedict equations?.  Nutr Clin Pract. 1996;  11 99-103
    Google Scholar
  • 32 Douglas C C, Lawrence J C, Bush N C et al. Ability of the Harris Benedict formula to predict energy requirements differs with weight history and ethnicity.  Nutr Res. 2007;  27 194-199
    Google Scholar
  • 33 Ogawa A M, Shikora S A, Burke L M et al. The thermodilution technique for measuring resting energy expenditure does not agree with indirect calorimetry for the critically ill patient.  JPEN J Parenter Enteral Nutr. 1998;  22 347-351
    Google Scholar
  • 34 Egi M, Bellomo R, Stachowski E et al. Blood glucose concentration and outcome of critical illness: the impact of diabetes.  Crit Care Med. 2008;  36 2249-2255
    Google Scholar
  • 35 Fogelholm R, Murros K, Rissanen A et al. Admission blood glucose and short-term survival in primary intracerebral haemorrhage: a population based study.  J Neurol Neurosurg Psychiatry. 2005;  76 349-353
    Google Scholar
  • 36 Worthley M I, Shrive F M, Anderson T J et al. Prognostic implication of hyperglycemia in myocardial infarction and primary angioplasty.  Am J Med. 2007;  120 643
    Google Scholar
  • 37 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
    Google Scholar
  • 38 Casaer M P, Mesotten D, Hermans G et al. Early versus late parenteral nutrition in critically ill adults.  N Engl J Med. 2011;  365 506-517
    Google Scholar
  • 39 Ibrahim E H, Mehringer L, Prentice D et al. Early versus late enteral feeding of mechanically ventilated patients: results of a clinical trial.  JPEN J Parenter Enteral Nutr. 2002;  26 174-181
    Google Scholar
  • 40 Villet S, Chiolero R L, Bollmann M D et al. Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients.  Clin Nutr. 2005;  24 502-509
    Google Scholar
  • 41 Faisy C, Lerolle N, Dachraoui F et al. Impact of energy deficit calculated by a predictive method on outcome in medical patients requiring prolonged acute mechanical ventilation.  Br J Nutr. 2009;  101 1079-1087
    Google Scholar
  • 42 Drover J W, Cahill N E, Kutsogiannis J et al. Nutrition therapy for the critically ill surgical patient: we need to do better!.  JPEN J Parenter Enteral Nutr. 2010;  34 644-652
    Google Scholar
  • 43 Kreymann K G, de Heer G, Felbinger T et al. Nutrition of critically ill patients in intensive care.  Internist (Berl). 2007;  48 1084-1092
    Google Scholar
  • 44 Berger M M, Soguel L. Feed the ICU patient ‘gastric’ first, and go post-pyloric only in case of failure.  Crit Care. 2010;  14 123
    Google Scholar
  • 45 Heyland D K, Dhaliwal R, Suchner U et al. Antioxidant nutrients: a systematic review of trace elements and vitamins in the critically ill patient.  Intensive Care Med. 2005;  31 327-337
    Google Scholar
  • 46 Artinian V, Krayem H, DiGiovine B. Effects of early enteral feeding on the outcome of critically ill mechanically ventilated medical patients.  Chest. 2006;  129 960-967
    Google Scholar
  • 47 Reignier J, Dimet J, Martin-Lefevre L et al. Before-after study of a standardized ICU protocol for early enteral feeding in patients turned in the prone position.  Clin Nutr. 2010;  29 210-216
    Google Scholar
  • 48 Khalid I, Doshi P, DiGiovine B. Early enteral nutrition and outcomes of critically ill patients treated with vasopressors and mechanical ventilation.  Am J Crit Care. 2010;  19 261-268
    Google Scholar
  • 49 Zaloga G P, Roberts P R, Marik P. Feeding the hemodynamically unstable patient: a critical evaluation of the evidence.  Nutr Clin Pract. 2003;  18 285-293
    Google Scholar
  • 50 Simpson F, Doig G S. Parenteral vs. enteral nutrition in the critically ill patient: a meta-analysis of trials using the intention to treat principle.  Intensive Care Med. 2005;  31 12-23
    Google Scholar
  • 51 Marik P E, Pinsky M. Death by parenteral nutrition.  Intensive Care Med. 2003;  29 867-869
    Google Scholar
  • 52 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.  Intensive Care Med. 2004;  30 1666-1671
    Google Scholar
  • 53 Singer P, Shapiro H, Bendavid I. Behind the ESPEN Guidelines on parenteral nutrition in the ICU.  Minerva Anestesiol. 2011;  77 1115-1120
    Google Scholar
  • 54 Kreymann K G, Adolph M, Druml W et al. Intensivmedizinische Leitlinie parenterale Ernährung der DGEM.  Aktuel Ernahrungsmed. 2007;  32 S89-S92
    Google Scholar
  • 55 Reid C. Frequency of under- and overfeeding in mechanically ventilated ICU patients: causes and possible consequences.  J Hum Nutr Diet. 2006;  19 13-22
    Google Scholar
  • 56 Griesdale D E, de Souza R J, van Dam R M et al. Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data.  CMAJ. 2009;  180 821-827
    Google Scholar
  • 57 Wiener R S, Wiener D C, Larson R J. Benefits and risks of tight glucose control in critically ill adults: a meta-analysis.  JAMA. 2008;  300 933-944
    Google Scholar
  • 58 Langouche L, Vanhorebeek I, van den Berghe G. Therapy insight: the effect of tight glycemic control in acute illness.  Nat Clin Pract Endocrinol Metab. 2007;  3 270-278
    Google Scholar
  • 59 Vriesendorp T M, DeVries J H, van Santen S et al. Evaluation of short-term consequences of hypoglycemia in an intensive care unit.  Crit Care Med. 2006;  34 2714-2718
    Google Scholar
  • 60 Vriesendorp T M, van Santen S, DeVries J H et al. Predisposing factors for hypoglycemia in the intensive care unit.  Crit Care Med. 2006;  34 96-101
    Google Scholar
  • 61 Chen B, Zhou Y, Yang P et al. Safety and efficacy of fish oil-enriched parenteral nutrition regimen on postoperative patients undergoing major abdominal surgery: a meta-analysis of randomized controlled trials.  JPEN J Parenter Enteral Nutr. 2010;  34 387-394
    Google Scholar
  • 62 Krinsley J S. Glycemic variability in critical illness and the end of Chapter 1.  Crit Care Med. 2010;  38 1206-1208
    Google Scholar
  • 63 Harris H W, Grunfeld C, Feingold K R et al. Chylomicrons alter the fate of endotoxin, decreasing tumor necrosis factor release and preventing death.  J Clin Invest. 1993;  91 1028-1034
    Google Scholar
  • 64 Read T E, Grunfeld C, Kumwenda Z L et al. Triglyceride-rich lipoproteins prevent septic death in rats.  J Exp Med. 1995;  182 267-272
    Google Scholar
  • 65 Kreymann K G, Berger M M, Deutz N E et al. ESPEN Guidelines on Enteral Nutrition: Intensive care.  Clin Nutr. 2006;  25 210-223
    Google Scholar
  • 66 Montejo J C, Minambres E, Bordeje L et al. Gastric residual volume during enteral nutrition in ICU patients: the REGANE study.  Intensive Care Med. 2010;  36 1386-1393
    Google Scholar
  • 67 Davies A R. Gastric residual volume in the ICU: can we do without measuring it?.  JPEN J Parenter Enteral Nutr. 2010;  34 160-162
    Google Scholar
  • 68 Cahill N E, Dhaliwal R, Day A G et al. Nutrition therapy in the critical care setting: what is „best achievable“ practice? An international multicenter observational study.  Crit Care Med. 2010;  38 395-401
    Google Scholar
  • 69 Clifford M E, Banks M D, Ross L J et al. A detailed feeding algorithm improves delivery of nutrition support in an intensive care unit.  Crit Care Resusc. 2010;  12 149-155
    Google Scholar
  • 70 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
    Google Scholar
  • 71 Brown R O, Hunt H, Mowatt-Larssen C A et al. Comparison of specialized and standard enteral formulas in trauma patients.  Pharmacotherapy. 1994;  14 314-320
    Google Scholar
  • 72 Moore F A, Moore E E, Kudsk K A et al. Clinical benefits of an immune-enhancing diet for early postinjury enteral feeding.  J Trauma. 1994;  37 607-615
    Google Scholar
  • 73 Kudsk K A, Li J, Renegar K B. Loss of upper respiratory tract immunity with parenteral feeding.  Ann Surg. 1996;  223 629-635; discussion 635–628
    Google Scholar
  • 74 Weimann A, Bastian L, Bischoff W E et al. Influence of arginine, omega-3 fatty acids and nucleotide-supplemented enteral support on systemic inflammatory response syndrome and multiple organ failure in patients after severe trauma.  Nutrition. 1998;  14 165-172
    Google Scholar
  • 75 Mendez C, Jurkovich G J, Garcia I et al. Effects of an immune-enhancing diet in critically injured patients.  J Trauma. 1997;  42 933-940; discussion 940–931
    Google Scholar
  • 76 Heyland D K, Novak F, Drover J W et al. Should immunonutrition become routine in critically ill patients? A systematic review of the evidence.  JAMA. 2001;  286 944-953
    Google Scholar
  • 77 Wischmeyer P. Nutritional pharmacology in surgery and critical care: ‘you must unlearn what you have learned’.  Curr Opin Anaesthesiol. 2011;  24 381-388
    Google Scholar
  • 78 McCowen K C, Bistrian B R. Immunonutrition: problematic or problem solving?.  Am J Clin Nutr. 2003;  77 764-770
    Google Scholar
  • 79 Heller A R, Fischer S, Rossel T et al. Impact of n-3 fatty acid supplemented parenteral nutrition on haemostasis patterns after major abdominal surgery.  Br J Nutr. 2002;  87 (S 01) S95-101
    Google Scholar
  • 80 Lee J Y, Sohn K H, Rhee S H et al. Saturated fatty acids, but not unsaturated fatty acids, induce the expression of cyclooxygenase-2 mediated through Toll-like receptor 4.  J Biol Chem. 2001;  276 16 683-16 689
    Google Scholar
  • 81 Serhan C N, Chiang N, Van Dyke T E. Resolving inflammation: dual anti-inflammatory and pro-resolution lipid mediators.  Nat Rev Immunol. 2008;  8 349-361
    Google Scholar
  • 82 Serhan C N, Savill J. Resolution of inflammation: the beginning programs the end.  Nat Immunol. 2005;  6 1191-1197
    Google Scholar
  • 83 Marik P E, Zaloga G P. Immunonutrition in critically ill patients: a systematic review and analysis of the literature.  Intensive Care Med. 2008;  34 1980-1990
    Google Scholar
  • 84 Gadek J E, DeMichele S J, Karlstad M D et al. 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. 1999;  27 1409-1420
    Google Scholar
  • 85 Pontes-Arruda A, Aragao A M, Albuquerque J D. Effects of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in mechanically ventilated patients with severe sepsis and septic shock.  Crit Care Med. 2006;  34 2325-2333
    Google Scholar
  • 86 Singer P, Theilla M, Fisher H et al. Benefit of an enteral diet enriched with eicosapentaenoic acid and gamma-linolenic acid in ventilated patients with acute lung injury.  Crit Care Med. 2006;  34 1033-1038
    Google Scholar
  • 87 Stapleton R D, Martin T R, Weiss N S et al. A phase II randomized placebo-controlled trial of omega-3 fatty acids for the treatment of acute lung injury.  Crit Care Med. 2011;  39 1655-1662
    Google Scholar
  • 88 Rice T W, Wheeler A P, Thompson B T et al. Enteral omega-3 fatty acid, gamma-linolenic acid, and antioxidant supplementation in acute lung injury.  JAMA. 2011;  306 1574-1581
    Google Scholar
  • 89 Wernerman J. Role of glutamine supplementation in critically ill patients.  Curr Opin Anaesthesiol. 2008;  21 155-159
    Google Scholar
  • 90 Roth E. Nonnutritive effects of glutamine.  J Nutr. 2008;  138 2025S-2031S
    Google Scholar
  • 91 Wernerman J. Glutamine and acute illness.  Curr Opin Crit Care. 2003;  9 279-285
    Google Scholar
  • 92 Wischmeyer P E. Clinical applications of L-glutamine: past, present, and future.  Nutr Clin Pract. 2003;  18 377-385
    Google Scholar
  • 93 Singleton K D, Wischmeyer P E. Glutamine induces heat shock protein expression via O-glycosylation and phosphorylation of HSF-1 and Sp1.  JPEN J Parenter Enteral Nutr. 2008;  32 371-376
    Google Scholar
  • 94 Garcia-de-Lorenzo A, Zarazaga A, Garcia-Luna P P et al. Clinical evidence for enteral nutritional support with glutamine: a systematic review.  Nutrition. 2003;  19 805-811
    Google Scholar
  • 95 Houdijk A P, Rijnsburger E R, Jansen J et al. Randomised trial of glutamine-enriched enteral nutrition on infectious morbidity in patients with multiple trauma.  Lancet. 1998;  352 772-776
    Google Scholar
  • 96 Conejero R, Bonet A, Grau T et al. Effect of a glutamine-enriched enteral diet on intestinal permeability and infectious morbidity at 28 days in critically ill patients with systemic inflammatory response syndrome: a randomized, single-blind, prospective, multicenter study.  Nutrition. 2002;  18 716-721
    Google Scholar
  • 97 Zhou Y P, Jiang Z M, Sun Y H et al. The effect of supplemental enteral glutamine on plasma levels, gut function, and outcome in severe burns: a randomized, double-blind, controlled clinical trial.  JPEN J Parenter Enteral Nutr. 2003;  27 241-245
    Google Scholar
  • 98 Singleton K D, Wischmeyer P E et al. Glutamine’s protection against sepsis and lung injury is dependent on heat shock protein 70 expression.  Am J Physiol Regul Integr Comp Physiol. 2007;  292 R1839-1845
    Google Scholar
  • 99 Hall J C, Dobb G, Hall J et al. A prospective randomized trial of enteral glutamine in critical illness.  Intensive Care Med. 2003;  29 1710-1716
    Google Scholar
  • 100 Jones C, Palmer T E, Griffiths R D. Randomized clinical outcome study of critically ill patients given glutamine-supplemented enteral nutrition.  Nutrition. 1999;  15 108-115
    Google Scholar
  • 101 Griffiths R D, Jones C, Palmer T E. Six-month outcome of critically ill patients given glutamine-supplemented parenteral nutrition.  Nutrition. 1997;  13 295-302
    Google Scholar
  • 102 Goeters C, Wenn A, Mertes N et al. Parenteral L-alanyl-L-glutamine improves 6-month outcome in critically ill patients.  Crit Care Med. 2002;  30 2032-2037
    Google Scholar
  • 103 Novak F, Heyland D K, Avenell A et al. Glutamine supplementation in serious illness: a systematic review of the evidence.  Crit Care Med. 2002;  30 2022-2029
    Google Scholar
  • 104 Tjader I, Rooyackers O, Forsberg A M et al. Effects on skeletal muscle of intravenous glutamine supplementation to ICU patients.  Intensive Care Med. 2004;  30 266-275
    Google Scholar
  • 105 Heyland D K, Dhaliwal R, Day A G et al. REducing Deaths due to OXidative Stress (The REDOXS Study): Rationale and study design for a randomized trial of glutamine and antioxidant supplementation in critically-ill patients.  Proc Nutr Soc. 2006;  65 250-263
    Google Scholar
  • 106 Jones N E, Heyland D K. Pharmaconutrition: a new emerging paradigm.  Curr Opin Gastroenterol. 2008;  24 215-222
    Google Scholar
  • 107 Berger M M, Chiolero R L. Antioxidant supplementation in sepsis and systemic inflammatory response syndrome.  Crit Care Med. 2007;  35 S584-590
    Google Scholar
  • 108 Angstwurm M W, Gaertner R. Practicalities of selenium supplementation in critically ill patients.  Curr Opin Clin Nutr Metab Care. 2006;  9 233-238
    Google Scholar
  • 109 Forceville X, Laviolle B, Annane D et al. Effects of high doses of selenium, as sodium selenite, in septic shock: a placebo-controlled, randomized, double-blind, phase II study.  Crit Care. 2007;  11 R73
    Google Scholar
  • 110 Heyland D K. Selenium supplementation in critically ill patients: can too much of a good thing be a bad thing?.  Crit Care. 2007;  11 153
    Google Scholar
  • 111 Avenell A, Noble D W, Barr J et al. Selenium supplementation for critically ill adults.  Cochrane Database Syst Rev 2004;  CD003703
    Google Scholar
  • 112 Andrews P J, Avenell A, Noble D W et al. Randomised trial of glutamine, selenium, or both, to supplement parenteral nutrition for critically ill patients.  BMJ. 2011;  342 d1542
    Google Scholar
  • 113 Popovic P J, Zeh 3rd H J, Ochoa J B. Arginine and immunity.  J Nutr. 2007;  137 1681S-1686S
    Google Scholar
  • 114 Bower R H, Cerra F B, Bershadsky B et al. Early enteral administration of a formula (Impact) supplemented with arginine, nucleotides, and fish oil in intensive care unit patients: results of a multicenter, prospective, randomized, clinical trial.  Crit Care Med. 1995;  23 436-449
    Google Scholar
  • 115 Bertolini G, Iapichino G, Radrizzani D et al. Early enteral immunonutrition in patients with severe sepsis: results of an interim analysis of a randomized multicentre clinical trial.  Intensive Care Med. 2003;  29 834-840
    Google Scholar
  • 116 Drover J W, Dhaliwal R, Weitzel L et al. Perioperative use of arginine-supplemented diets: a systematic review of the evidence.  J Am Coll Surg. 2011;  212 385-399, 399 e381
    Google Scholar
  • 117 Ligthart-Melis G C, van de Poll M C, Boelens P G et al. Glutamine is an important precursor for de novo synthesis of arginine in humans.  Am J Clin Nutr. 2008;  87 1282-1289
    Google Scholar
  • 118 Coeffier M, Dechelotte P. Combined infusion of glutamine and arginine: does it make sense?.  Curr Opin Clin Nutr Metab Care. 2010;  13 70-74
    Google Scholar

Priv.-Doz. Dr. med. Thomas W. Felbinger

Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Klinikum Neuperlach, Städtisches Klinikum München GmbH

Oskar-Maria-Graf-Ring 51

81377 München

Email: thomas.felbinger@klinikum-muenchen.de

      >