Lungenersatzverfahren – Wenn Beatmung alleine nicht mehr reicht: Extrakorporale Lungenassistenzverfahren

Zusammenfassung

Extrakorporale Lungenassistenzverfahren können pumpenlos arterio-venös oder pumpengetrieben veno-venös eingesetzt werden und dienen nur der CO₂-Elimination, entsprechen also einer extrakorporalen Ventilation. Die Oxygenierung als Funktion des mittleren Atemwegsdrucks muß respiratorunterstützt über die Patientenlunge sichergestellt werden.

In der Behandlung des akuten Lungenversagens werden extrakorpale Lungenassistenzverfahren eingesetzt, um im Rahmen eines multimodalen Behandlungskonzeptes die Invasivität der mechanischen Beatmung weiter zu senken. Gelänge es damit, die pulmonale und systemische Entzündungsreaktion zu reduzieren, könnte sich ein positiver Effekt auf das Outcome ergeben, da das Multiorganversagen nach wie vor die häufigste Todesursache beim akuten Lungenversagen darstellt. Eine weitere große Patientengruppe, die zukünftig möglicherweise von einer extrakorporalen Ventilation profitieren könnte, sind Patienten mit einer akuten Exazerbationen einer chronisch obstruktiven Lungenerkrankung.

Abstract

Extracorporeal lung assist can be performed pumpless by using the arterio-venous driving pressure or pumpdriven in a veno-venous mode. Oxygenation is maintained via the native lungs and depends mainly on mean airway pressure during mechanical ventilation.

Extracorporeal lung assist can be part of a multimodal treatment concept in patients with acute lung injury. It aims at a further reduction of the applied tidal volume and peak pressures in order to reduce the intensity of the pulmonary and systemic inflammatory response which is the main factor for the development of multi-organ failure in this group of patients. Eventually patients with acute exacerbation of a chronic pulmonary disease might also benefit from extracorporeal ventilation.

Schlüsselwörter

Extrakorporale Lungenassistenz - Akutes Lungenversagen - avECLA - vvECCO₂-R - COPD

Keywords

Extracorporeal lung assist - Acute respiratory distress syndrome - avECLA - vvECCO₂-R - COPD

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