Akutes Lungenversagen (ARDS) – Update

Das akute Lungenversagen (Acute Respiratory Distress Syndrome, ARDS) ist eine komplexe Herausforderung mit hoher Mortalität und Morbidität. Die Mortalität ist abhängig vom Schweregrad und kann bei schweren Fällen 40–60% betragen [1]. Besondere Aufmerksamkeit mit hoher Forschungsintensität und neuen Einblicken erhielt das ARDS in den letzten Jahren durch die COVID-19-Pandemie. Systematisch entwickelte Handlungsempfehlungen zur Therapie des ARDS finden sich in der S3-Leitlinie „Invasive Beatmung und Einsatz extrakorporaler Verfahren bei akuter respiratorischer Insuffizienz“ [2].

Kernaussagen

• Die Pneumonie bzw. Sepsis mit pulmonalem Fokus ist die häufigste Ursache für das akute Lungenversagen (Acute Respiratory Distress Syndrome, ARDS).

• Klinisch stehen Dyspnoe und fortschreitende Hypoxämie mit akutem Beginn und oft rascher Verschlechterung im Vordergrund. Letztlich stellt das ARDS eine Systemerkrankung mit Multiorganversagen dar.

• Die Einteilung der Schweregrade erfolgt anhand der Berlin-Kriterien; die Diagnostik schließt CT, mikrobiologische Diagnostik und ggf. Echokardiografie ein.

• Die lungenprotektive Beatmung ist die Grundlage der invasiven Beatmungsstrategie bei ARDS. Ein Δp von max. 14–15 cmH₂O sollte die Wahl des geeigneten TV bestimmen.

• Trotz des eindeutigen Benefits und niedriger Komplikationsraten sowie einer eindeutigen Leitlinienempfehlung der Bauchlagerung bei moderatem und schwerem ARDS wird diese oftmals nicht konsequent angewandt; hier liegt noch Verbesserungspotenzial.

• Im ARDS existieren zum gleichen Zeitpunkt in verschiedenen Lungenabschnitten atelektatische, regulär belüftete und überblähte Bereiche. Rekrutierungsmanöver mit hohen Drücken sollten nicht erfolgen.

• Darüber hinaus sind supportive Therapiemaßnahmen zu nennen in Form von venovenöser ECMO (vvECMO), Muskelrelaxierung, Gabe von Glukokortikoiden.

Schlüsselwörter

respiratorische Insuffizienz - Beatmung - Dyspnoe - Intensivmedizin - ECMO

Publication History

Article published online:
25 June 2025

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