Stellenwert der invasiven Diagnostik beim akuten Lungenversagen

Zusammenfassung

Ein akutes Lungenversagen kann durch eine Vielzahl von Krankheitsentitäten ausgelöst werden. Neben supportiven Maßnahmen, einschließlich lungenprotektiver Beatmung, stellt die Kenntnis der auslösenden Ursache den Schlüssel zur optimalen Therapie des Lungenversagens dar. In den meisten Fällen gelingt es mittels Anamnese, Klinik, Labor und Radiologie die Ursache des Lungenversagens zu klären. Im Einzelfall kann die Differentialdiagnose trotz umfangreicher Diagnostik offen bleiben. In dieser Situation gilt es, die Gefahren einer empirischen Therapie gegen die Risiken einer invasiven Diagnostik im Sinne einer chirurgischen Lungenbiopsie abzuwägen. Mittlerweile liegen Berichte von Lungenbiopsien an über 500 Patienten mit akutem Lungenversagen vor, die einen relevanten diagnostischen Informationsgewinn bei akzeptablem Risiko belegen. Intensivmediziner sollten daher die Lungenbiopsie in Erwägung ziehen, wenn die Ätiologie eines akuten Lungenversagens trotz umfangreicher Diagnostik nicht zu klären ist.

Abstract

Acute lung injury/acute respiratory distress syndrome (ARDS) may be induced by a variety of disease entities. Apart from supportive treatment including lung protective ventilation, identification of the underlying process is of crucial importance for optimal therapeutic results. Usually the cause of ARDS can be identified by history, laboratory and radiologicial tests. In some cases a diagnosis cannot be made in spite of an extensive, less invasive diagnostic work-up. In these situations the risks of empirical treatment have to be balanced against the procedural risk of invasive diagnostics, namely open lung biopsy. Today, reports on more than 500 lung biopsies performed in selected ARDS patients are available showing a relevant diagnostic yield at an acceptable procedure-associated risk. Intensive care physicians should be aware of this diagnostic instrument, which can represent the decisive diagnostic step in patients with ARDS of unknown origin.

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