S2k-Leitlinie – Empfehlungen zur stationären Therapie von Patienten mit COVID-19

S. Kluge; U. Janssens; T. Welte; S. Weber-Carstens; G. Schälte; C. D. Spinner; J. J. Malin; P. Gastmeier; F. Langer; M. Wepler; M. Westhoff; M. Pfeifer; K. F. Rabe; F. Hoffmann; B. W. Böttiger; J. Weinmann-Menke; A. Kersten; P. Berlit; R. Haase; G. Marx; C. Karagiannidis

doi:10.1055/a-1334-1925

Pneumologie, Table of Contents

Pneumologie 2021; 75(02): 88-112
DOI: 10.1055/a-1334-1925

Leitlinie

S2k-Leitlinie – Empfehlungen zur stationären Therapie von Patienten mit COVID-19^[*]

S2k Guideline – Recommendations for Inpatient Therapy of Patients with COVID-19

Authors

S. Kluge

¹Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN); Berlin

²Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin

³Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin

¹⁰ARDS Netzwerk Deutschland, Berlin
U. Janssens

¹Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN); Berlin

²Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin

¹⁰ARDS Netzwerk Deutschland, Berlin
T. Welte

¹Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN); Berlin

³Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin

¹⁰ARDS Netzwerk Deutschland, Berlin
S. Weber-Carstens

²Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin

⁴Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg

¹⁰ARDS Netzwerk Deutschland, Berlin
G. Schälte

⁴Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg
C. D. Spinner

⁵Deutsche Gesellschaft für Infektiologie (DGI), Berlin
J. J. Malin

⁵Deutsche Gesellschaft für Infektiologie (DGI), Berlin
P. Gastmeier

⁶Deutsche Gesellschaft für Hygiene und Mikrobiologie (DGHM), Münster
F. Langer

⁷Gesellschaft für Thrombose und Hämostaseforschung (GTH), Köln
M. Wepler

⁴Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg
M. Westhoff

³Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin
M. Pfeifer

³Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin
K. F. Rabe

³Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin
F. Hoffmann

²Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin

⁸Deutsche Gesellschaft für Kinder- und Jugendmedizin (DGKJ), Berlin
B. W. Böttiger

²Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin

⁹Deutscher Rat für Wiederbelebung (German Resuscitation Council; GRC), Ulm
J. Weinmann-Menke

¹¹Deutsche Gesellschaft für Nephrologie (DGfN)
A. Kersten

¹²Deutsche Gesellschaft für Kardiologie (DGK)
P. Berlit

¹³Deutsche Gesellschaft für Neurologie (DGN)
R. Haase

¹⁴Patientenvertretung (individueller Betroffener)
G. Marx

²Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin

⁴Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg

¹⁰ARDS Netzwerk Deutschland, Berlin
C. Karagiannidis

¹Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN); Berlin

²Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin

³Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin

¹⁰ARDS Netzwerk Deutschland, Berlin

Abstract

Zusammenfassung

Seit Dezember 2019 verbreitet sich das neuartige Coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome – Corona Virus-2) rasch im Sinne einer weltweiten Pandemie. Dies stellt Kliniker und Krankenhäuser vor große Herausforderungen und belastet die Gesundheitssysteme vieler Länder in einem nie dagewesenen Ausmaß. Die Mehrheit der Patienten mit Coronavirus Disease 2019 (COVID-19) zeigt lediglich milde Symptome wie Husten und Fieber. Allerdings benötigen etwa 8 % eine stationäre Behandlung. Der frühzeitigen Klärung, ob eine stationäre und ggfs. intensivmedizinische Behandlung medizinisch sinnvoll und vom Patienten gewollt ist, kommt in der Pandemie eine besondere Bedeutung zu. Die akute hypoxämische respiratorische Insuffizienz mit Dyspnoe und hoher Atemfrequenz (> 30/min) führt i. d. R. zur Aufnahme auf die Intensivstation. Oft finden sich dann bereits bilaterale pulmonale Infiltrate/Konsolidierungen oder auch Lungenembolien in der Bildgebung. Im weiteren Verlauf entwickeln einige dieser Patienten ein akutes Lungenversagen (Acute Respiratory Distress Syndrome; ARDS). Eine Sterblichkeitsreduktion einer verfügbaren medikamentösen Therapie bei schwerer COVID-19-Erkrankung ist bisher lediglich für Dexamethason in randomisiert, kontrollierten Studien nachgewiesen. Das Hauptziel der supportiven Therapie besteht in der Sicherstellung einer ausreichenden Oxygenierung. Die invasive Beatmung und wiederholte Bauchlagerung sind dabei wichtige Elemente in der Behandlung von schwer hypoxämischen COVID-19-Patienten. Die strikte Einhaltung der Basishygiene, einschließlich der Händehygiene, sowie das korrekte Tragen von adäquater persönlicher Schutzausrüstung sind im Umgang mit den Patienten unabdingbar. Medizinisch notwendige Handlungen am Patienten, die zur Aerosolbildung führen könnten, sollten mit äußerster Sorgfalt und Vorbereitung durchgeführt werden.

Abstract

Since December 2019, the novel coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome – Corona Virus-2) has been spreading rapidly in the sense of a global pandemic. This poses significant challenges for clinicians and hospitals and is placing unprecedented strain on the healthcare systems of many countries. The majority of patients with Coronavirus Disease 2019 (COVID-19) present with only mild symptoms such as cough and fever. However, about 6 % require hospitalization. Early clarification of whether inpatient and, if necessary, intensive care treatment is medically appropriate and desired by the patient is of particular importance in the pandemic. Acute hypoxemic respiratory insufficiency with dyspnea and high respiratory rate (> 30/min) usually leads to admission to the intensive care unit. Often, bilateral pulmonary infiltrates/consolidations or even pulmonary emboli are already found on imaging. As the disease progresses, some of these patients develop acute respiratory distress syndrome (ARDS). Mortality reduction of available drug therapy in severe COVID-19 disease has only been demonstrated for dexamethasone in randomized controlled trials. The main goal of supportive therapy is to ensure adequate oxygenation. In this regard, invasive ventilation and repeated prone positioning are important elements in the treatment of severely hypoxemic COVID-19 patients. Strict adherence to basic hygiene, including hand hygiene, and the correct wearing of adequate personal protective equipment are essential when handling patients. Medically necessary actions on patients that could result in aerosol formation should be performed with extreme care and preparation.

Full Text

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S2k-Leitlinie – Empfehlungen zur stationären Therapie von Patienten mit COVID-19[*]

Authors

S2k-Leitlinie – Empfehlungen zur stationären Therapie von Patienten mit COVID-19^[*]