Der erhöhte intrakranielle Druck – Therapiemaßnahmen

Christoph Rosenthal; Stefan Wolf; Steffen Weber-Carstens; Farid Salih

doi:10.1055/s-0032-1301379

AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie, Table of Contents

Anästhesiol Intensivmed Notfallmed Schmerzther 2012; 47(1): 30-39
DOI: 10.1055/s-0032-1301379

Fachwissen

Anästhesie & Intensivmedizin Topthema: Der erhöhte intrakranielle Druck

Der erhöhte intrakranielle Druck – Therapiemaßnahmen

Intracranial hypertension – Therapeutic options

Authors

Christoph Rosenthal
Stefan Wolf
Steffen Weber-Carstens
Farid Salih

Abstract

Zusammenfassung

Ein erhöhter intrakranieller Druck kann die Folge verschiedener intrakranieller Pathologien sein. Persistierend hohe Werte über 20–25 mmHg führen eigenständig durch Perfusionsstörungen oder direkten Druck zu einer weiteren Schädigung des Gehirns führen. Dies kann für das neurologische Behandlungsergebnis und damit für das weitere Leben des Betroffenen katastrophale Folgen haben. Ein zentrales Krankheitsbild, das mit einer vital bedrohlichen intrakraniellen Druckerhöhung einhergehen kann, ist das Schädelhirntrauma. Die hieran entwickelten und zum Teil auch auf andere Pathologien mit erhöhtem intrakraniellen Druck übertragenen Behandlungsansätze basieren auf Basistherapiemaßnahmen, die um Eskalationsstufen ergänzt sind. Trotz der enormen gesellschaftlichen, medizinischen und ökonomischen Bedeutung einer effektiven Therapie des erhöhten intrakraniellen Druckes besteht aktuell nur wenig Evidenz für viele der auch in Leitlinien empfohlenen Therapiemaßnahmen.

Summary

Increased intracranial pressure can be the result of different intracranial pathologies. Sustained intracranial pressure above 20–25 mmHg may cause secondary brain injury by impaired cerebral perfusion or direct pressure with neuronal injury, with in consequence deterioration of neurological outcome. A main cause of critically increased intracranial pressure is traumatic brain injury. Most treatment strategies for increased intracranial pressure were developed and studied on these patients. Most of them were transferred to other pathologies with increased intracranial pressure.

Treatment is based on general measures, which can be escalated for medical and surgical options in case of failure to sufficiently decrease intracranial pressure below the established threshold. Despite its enormous medical and socio-economical relevance, the evidence for most treatment strategies of intracranial hypertension, though published in guidelines, is weak.

Schlüsselwörter:

intrakranieller Druck - Therapiemaßnahmen - Schädelhirntrauma - Evidenz

Keywords:

intracranial hypertension - therapy - traumatic brain injury - evidence

Full Text

References

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