Tod durch parenterale Ernährung?

Current practice in nutritional support and its association with mortality in septic patients-results from a national, prospective, multicenter study.

Gunnar E, Schädler D, Engel C, et al.                                                                                                                        Crit Care Med 2008; 36:1762-7

Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Germany.

OBJECTIVE: To identify current clinical practice regarding nutrition and its association with morbidity and mortality in patients with severe sepsis or septic shock in Germany.
DESIGN: Nationwide prospective, observational, cross-sectional, 1-day point-prevalence study.
SETTING: The study included 454 intensive care units from a representative sample of 310 hospitals stratified by size.
PATIENTS: Participants were 415 patients with severe sepsis or septic shock (according to criteria of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference).
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Data were collected by on-site audits of trained external study physicians during randomly scheduled visits during 1 yr. Valid data on nutrition were available for 399 of 415 patients. The data showed that 20.1% of patients received exclusively enteral nutrition, 35.1% exclusively parenteral nutrition and 34.6% mixed nutrition (parenteral and enteral); 10.3% were not fed at all. Patients with gastrointestinal/ intra-abdominal infection, pancreatitis or neoplasm of the gastrointestinal tract, mechanical ventilation or septic shock were less likely to receive exclusively enteral nutrition. Median Acute Physiology and Chronic Health Evaluation II and Sepsis-related Organ Failure Assessment scores were significantly different among the nutrition groups.
Overall hospital mortality was 55.2%. Hospital mortality was significantly higher in patients receiving exclusively parenteral (62.3%) or mixed nutrition (57.1%) than in patients with exclusively enteral nutrition (38.9%) (p = .005). After adjustment for patient morbidity (Acute Physiology and Chronic Health Evaluation II score, presence of septic shock) and treatment factors (mechanical ventilation), multivariate analysis revealed that the presence of parenteral nutrition was significantly predictive of mortality (odds ratio, 2.09; 95% confidence interval, 1.29-3.37).
CONCLUSIONS: Patients with severe sepsis or septic shock in German intensive care units received preferentially parenteral or mixed nutrition. The use of parenteral nutrition was associated with an increased risk of death.