Zusammenfassung
GRUNDLAGEN: Ernährung beim kritisch Kranken und Schwerverletzten ist essentiell und kann parenteral oder enteral erfolgen. Jede Methode hat ihre Vor-und Nachteile. Hier untersuchen wir den enteralen Zugang, vor allem die Zugangswege. METHODIK: Übersicht der Literatur. ERGEBNISSE: Folgende Zugangswege für enterale Ernährungssonden stehen uns zur Verfügung: orogastrisch, nasogastrisch, nasojejunal. Die beliebtere Methode ist die permanente endoskopische Gastrostomie (PEG), aus ökonomischen und sicherheitstechnischen Überlegungen. Alternativ finden sich die offene Gastrostomie, laparoskopische oder laparoskopisch assistierte Gastrostomie und Jejunostomie. SCHLUSSFOLGERUNGEN: Wann immer ein enteraler Zugang möglich ist, sollte einer enteralen Ernährung der Vorzug gegeben werden, ob prä- oder post-pylorisch ist derzeit nicht eindeutig zu beantworten. PEG ist sicher und ökonomisch sinnvoll.
Summary
BACKGROUND: Nutritional support in critically ill and injured patients is crucial. It can be provided via parenteral or enteral access, each of which has advantages and disadvantages. In this article, we review enteral support, particularly gut access. METHODS: We conducted a literature review. RESULTS: A number of techniques enable access to the gastrointestinal tract in critically ill and injured patients. A temporary orogastric (OG), nasogastric (NG), or nasojejunal (NJ) feeding tube can be placed. But the prevalent technique is the more permanent percutaneous endoscopic gastrostomy (PEG), which has economic as well as safety benefits. Other techniques include open operative gastrostomy, laparoscopic or laparoscopic-assisted gastrostomy, and jejunostomy. CONCLUSIONS: Nutritional support should be provided enterally, via gut access whenever possible. The issue of pre- versus post-pyloric access remains controversial. PEG is safe and economical for long-term access.
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Kulvatunyou, N., Joseph, B., Tang, A. et al. Gut access in critically ill and injured patients: Where have we gone thus far?. Eur Surg 43, 24–29 (2011). https://doi.org/10.1007/s10353-011-0590-1
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DOI: https://doi.org/10.1007/s10353-011-0590-1