Fettemulsionen bei Sepsis und SIRS

Zusammenfassung

SIRS und Sepsis sind Erkrankungen mit alternierenden hyper- und hypoinflammtorischen Phasen, die trotz großen Fortschritten der modernen Intensivmedizin mit hoher Sterblichkeit einhergehen. Da septische Patienten oft parenteral ernährt werden müssen, stellen Lipidemulsionen aufgrund der Umstellungen des Stoffwechsels auf die Oxidation von Lipiden in der Sepsis die Basis der Ernährungstherapie dar. Neben der wichtigen Funktion als Kalorienträger und Zellmembranbaustein besitzen Lipidemulsionen die Eigenschaft, das Immunsystem septischer Patienten erheblich zu beeinflussen. Die Infusion von LCT-basierten Infusionen kann in diesen Patienten zu einer Verstärkung der Immunsuppression oder Hyperinflammation führen. Ursache hierfür könnte die erhöhte Zufuhr und Verfügbarkeit von n-6 mehrfach ungesättigten Fettsäuren (PUFA) sein. Der Einsatz von LCT-/MCT- oder olivenölbasierten Emulsionen stellt eine Möglichkeit zur Reduktion der PUFA-Zufuhr dar. N-3-Fettsäuren sind alternative Präkursoren für die Synthese von Prostaglandinen, Thromboxan und Leukotrienen, ihre Integration in die Infusionstherapie bietet den Vorteil der Reduktion der n-6-PUFAs in den verwendeten Emulsionen. Ein weiterer Nutzen stellt die Verschiebung des n-6-/n-3-Verhältnisses zu einer immunneutraleren Ratio dar. Beides könnte sich in der parenteralen Ernährung septischer Patienten als vorteilhaft erweisen.

Abstract

SIRS and sepsis are diseases with alternating hyper- and hypo-inflammatory phases in spite of major advances in intensive care medicine being associated with high rates of mortality. Lipid emulsions are the mainstay of nutrional therapy as septic patients often present with the need for parenteral nutrition and their metabolic response has changed to the oxidation of lipids. Lipid emulsions have a massive impact of the immune system of septic patients next to their function of serving as caloric support and building blocks for the cell membrane. Infusion of LCT-based emulsions may either increase the immunosuppression or hyper-inflammation in septic patients. A possible reason for this is the increased supply and availability of n-6 polyunsaturated fatty acids. The use of LCT/MCT- or olive oil-based emulsions may be an option to reduce the supply of polyunsaturated fatty acids. N-3 fatty acids are alternative precursors for the synthesis of prostaglandins, thromboxane, and leukotrienes; their integration into infusion therapy offers the advantage of reducing n-6 polyunsaturated fatty acids in the used emulsions. A further benefit is the shift of the n-6/n-3 ratio to a more immuno-neutral proportion. Both changes may be of benefit for the parenteral nutrition of septic patients.

Schlüsselwörter

Lipidemulsionen - Sepsis - Lipidmediatoren - Patienten - n-3-Fettsäuren

Key words

Lipid emulsions - sepsis - lipid mediators - patients - n-3 fatty acids

Literatur

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