Adipositas in der Intensivmedizin

Ein adipöser Patient, der intensivmedizinisch behandelt werden muss, ist neben ökonomischen Aspekten sowohl medizinisch, pflegerisch als auch physiotherapeutisch eine große Herausforderung für das gesamte Team. Intubation und Beatmung, angepasste Dosierung der medikamentösen Therapie, adäquate Ernährung und die Mobilisation sind nur einige der zahlreichen Aspekte, auf die dieser Beitrag eingeht.

Abstract

The prevalence of obesity and its associated comorbidities are increasing worldwide, leading to a rising proportion of obese patients in hospitals and intensive care units. This trend is causing a significant additional burden on our healthcare system. An obese patient requiring intensive care treatment presents major challenges for the entire team, not only in terms of economic aspects but also medically, in nursing care, and in physiotherapy. Additionally, psychosocial and organizational factors play a role that must be considered. For nursing and physiotherapy, appropriate aids such as lifters, special large hospital beds, suitable rooms, and adequate staffing should be provided. The medical challenges include intubation and airway management, hemodynamic monitoring, vascular access, adequate nutrition, appropriate dosing of medication, and difficult ultrasound conditions at the bedside. Furthermore, this patient population has an increased risk of developing pressure ulcers, pneumonia, and thrombosis, which increase the overall care requirements and further challenge the intensive care setting.

Kernaussagen

• Die Anzahl adipöser Patienten auf Intensivstationen nimmt kontinuierlich zu, insbesondere in der jüngeren Altersgruppe bis 35 Jahre.

• Studien zeigen, dass selbst eine ausgeprägte Adipositas die Mortalität im Vergleich zu normalgewichtigen Intensivpatienten nicht wesentlich erhöht.

• Trotz vermehrt auftretender Komorbiditäten scheint Adipositas einen protektiven Effekt auf das Outcome von Intensivpatienten zu haben, was als „Obesitas-Paradoxon“ bezeichnet wird.

• Adipöse Patienten haben ein reduziertes Lungenvolumen, was die Atemarbeit und den Sauerstoffverbrauch erhöht. Dies macht die Atemwegssicherung mittels Maskenbeatmung und Intubation schwieriger.

• Das Risiko für lebensbedrohliche Komplikationen bei der Intubation ist bei adipösen Patienten deutlich höher als bei normalgewichtigen Patienten. Spezifische Vorkehrungen sind notwendig, um das Risiko zu minimieren.

• Die Beatmung adipöser Patienten erfordert spezielle Anpassungen. Diese umfassen z.B. die Lagerung und den Einsatz von CPAP (Continuous Positive Airway Pressure) oder NIV mit erhöhtem PEEP zur Verbesserung des Lungen-Recruitments und der Sauerstoffversorgung.

• Trotz Übergewicht können adipöse Patienten bei Aufnahme auf die Intensivstation mangelernährt sein. Eine frühzeitige und möglichst enterale Ernährung ist anzustreben.

• Bei stark adipösen Patienten können die Verteilung, der Abbau und die Ausscheidung von Medikamenten verändert sein. Dies erfordert eine Dosis-Anpassung zahlreicher Medikamente.

Schlüsselwörter

Adipositas - Intensivstation - Ernährung - Medikation - Sonografie - Beatmung

Keywords

obesity - Intensive Care Unit - nutrition - medication - sonography - mechanical ventilation

Publikationsverlauf

Artikel online veröffentlicht:
06. Mai 2025

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