gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Parenteral and enteral nutrition affects management and outcome in neurosurgical ICU patients

Parenterale und enterale Ernährung beeinflusst das Management und das Outcome von Patienten auf neurochirurgischen Intensivstationen

Meeting Abstract

  • corresponding author M. Oertel - Neurochirurgische Klinik, Universitätsklinikum Gießen-Marburg GmbH, Standort Gießen
  • J. Grünschläger - Ernährungsteam, Universitätsklinikum Gießen-Marburg GmbH, Standort Gießen
  • B. Müller - Neurochirurgische Klinik, Universitätsklinikum Gießen-Marburg GmbH, Standort Gießen
  • A. Hauenschild - Ernährungsteam, Universitätsklinikum Gießen-Marburg GmbH, Standort Gießen
  • M. Stein - Neurochirurgische Klinik, Universitätsklinikum Gießen-Marburg GmbH, Standort Gießen
  • D.-K. Böker - Neurochirurgische Klinik, Universitätsklinikum Gießen-Marburg GmbH, Standort Gießen

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocDO.05.10

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2007/07dgnc046.shtml

Veröffentlicht: 11. April 2007

© 2007 Oertel et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Iatrogenic malnutrition on neurosurgical intensive care units (ICU) is an underestimated phenomenon. It may cause a decrease in plasma albumin and oncotic pressure. As a result, an increase of free water could shift into the brain and increase intracranical pressure (ICP). This study was conducted to test the hypothesis that a combined parenteral and enteral high protein nutrition is beneficial for neurosurgical ICU patients.

Methods: A total of 202 neurosurgical ICU patients (age 56±16 years, m:f=1.2:1) were studied. Two 1-year time periods were compared during which two different nutritional regimens were followed. In the first year (Y1) a low-protein-high-fat parenteral nutrition was given and followed by a standard enteral regimen. In the second year (Y2) a protein-rich, combined parenteral and enteral diet was administered. The following clinical parameters were recorded across the first two weeks after admission: ICP, albumin, cholinesterase, daily hours of ICP>20 mm Hg and CPP<70 mm Hg, APACHE II score and Glasgow Outcome Score (GOS) at 3 months after discharge.

Results: Overall albumin (32.4±4.1 g/l vs 27.5±3.6 g/l) and cholinesterase weresignificantly higher during Y2 although total energy supply, glucose and fat intake were significantly lower. A favorable outcome was seen when patients had lower APACHE II scores and received a Y2 nutritional regimen. The total hours of ICP>20 mm Hg were less during Y2. With the Y2 nutrition less catecholamines and colloidal fluid replacement was necessary to maintain adequate cerebral perfusion.

Conclusions: Adequate nutrition is an important factor for the favourable outcome of neurosurgical ICU patients.