Die neue S3-Leitlinie „Intensivmedizin nach Polytrauma“

Die neue S3-Leitlinie „Intensivmedizin nach Polytrauma“ [1] setzt einen wichtigen Meilenstein in der Versorgung polytraumatisierter Patient*innen in Deutschland. Sie bündelt aktuelle wissenschaftliche Erkenntnisse, gibt praxisnahe Empfehlungen für das intensivmedizinische Management nach Polytrauma und leistet damit einen wertvollen Beitrag zur Standardisierung und Verbesserung der Versorgung Schwerstverletzter in Deutschland.

Abstract

The inaugural edition of the S3 guideline “Intensive Care after Polytrauma” represents a pivotal advancement in standardizing and improving the care of severely injured patients. Developed by an interdisciplinary panel of experts and grounded in a rigorous methodology aligned with AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V.) standards, the guideline addresses critical aspects of polytrauma management, including diagnostics, hemodynamic and respiratory therapy, surgical timing, bleeding control, nutritional support, and ethical decision-making. Despite a comprehensive literature review, substantial evidence gaps persist for this complex patient population. The guideline compensates with consensus-based recommendations informed by clinical expertise and existing high-level guidelines, thus offering actionable guidance in areas lacking robust data. Emphasis is placed on interdisciplinary collaboration and structured communication, particularly relevant in addressing logistical challenges in trauma care delivery. Recommendations are tailored to current clinical practices, acknowledging both technological limitations in rural settings and the variability in patient conditions. Notably, the guideline calls attention to the urgent need for high-quality research in areas such as ethical algorithms, individualized ventilatory strategies, and thromboembolic prophylaxis. Through its pragmatic, evidence-informed approach and integration of established guidance, this S3 guideline provides a clinically valuable and adaptable framework for the intensive care treatment of polytrauma patients, while highlighting areas of critical scientific uncertainty.

Schlüsselwörter

Leitlinie - ARDS - acute respiratory Distress Syndrome - Intensivmedizin

Keywords

guideline - ARDS - acute respiratory distress syndrome - intensive care

Publication History

Article published online:
09 September 2025

• Literatur

• 1 Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin – DIVI. et al. Intensivmedizin nach Polytrauma. Register Nr. 040/014. AWMF 2024, gültig bis 2029. https://register.awmf.org/de/leitlinien/detail/040-014
• 2 Fathi M, Mirjafari A, Yaghoobpoor S. et al. Diagnostic utility of whole-body computed tomography/pan-scan in trauma: a systematic review and meta-analysis study. Emerg Radiol 2024; 31: 251-68
• 3 Granieri S, Altomare M, Bonomi A. et al. Contrast-enhanced CT scan (CECT) for the detection of hollow viscus and mesenteric injuries in blunt trauma – an updated systematic review of the literature and meta-analysis of diagnostic test accuracy. Eur J Trauma Emerg Surg 2024; 50: 2709-2719
• 4 Ma X, Dong Z, Wang Y. et al. Risk factors analysis of thoracic trauma complicated with acute respiratory distress syndrome and observation of curative effect of lung-protective ventilation. Front Surg 2021; 8: 826682
• 5 Yang P, Sjoding MW. Acute Respiratory distress syndrome: definition, diagnosis, and routine management. Crit Care Clin 2024; 40: 309-327
• 6 Deutsche Gesellschaft für Anästhesie & Intensivmedizin – DGAI (federführend). Invasive Beatmung und Einsatz extrakorporaler Verfahren bei akuter respiratorischer Insuffizienz. Register Nr. 001/021. AWMF 2017, gültig bis 2022 (in Überarbeitung). https://register.awmf.org/de/leitlinien/detail/001-021
• 7 Tubert P, Kalimouttou A, Bouzat P. et al. Are crystalloid-based fluid expansion strategies still relevant in the first hours of trauma induced hemorrhagic shock?. Crit Care 2024; 28: 416
• 8 Deutsche Gesellschaft für Anästhesie & Intensivmedizin – DGAI (federführend). Intravasale Volumentherapie bei Erwachsenen. Register Nr. 001/020. AWMF 2020, gültig bis 2025. https://register.awmf.org/assets/guidelines/001-020l_S3_Intravasale-Volumentherapie-Erwachsene_2020-10.pdf
• 9 Ting RS, Weaver NA, King KL. et al. Epidemiology of postinjury multiple organ failure: a prospective multicenter observational study. Eur J Trauma Emerg Surg 2024; 50: 3223-3231
• 10 Halvachizadeh S, Pfeifer R, Duncan J. et al. Does the injury pattern drive the surgical treatment strategy in multiply injured patients with major fractures?. J Trauma Acute Care Surg 2024; 96: 931-937
• 11 Rossaint R, Afshari A, Bouillon B. et al. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition. Crit Care 2023; 27: 80
• 12 Jones AR, Miller J, Brown M. Epidemiology of trauma-related hemorrhage and time to definitive care across north america: making the case for bleeding control education. Prehosp Disaster Med 2023; 38: 780-783
• 13 Enke A, Haas S, Kopp I. et al. Prophylaxe der venösen Thromboembolie (VTE). Register Nr. 003/001. AWMF 2015, gültig bis 2020 (in Überarbeitung). https://register.awmf.org/de/leitlinien/detail/003-001
• 14 Deutsche Gesellschaft für Ernährungsmedizin – DGEM. et al. „Klinische Ernährung in der Intensivmedizin“ S2k-Leitlinie. Register Nr. 073-004. AWMF 2018, gültig bis 2023 (in Überarbeitung). https://register.awmf.org/de/leitlinien/detail/073-004