Akutes Lungenversagen – ein Update

Zusammenfassung

Das akute Lungenversagen (ARDS) ist gekennzeichnet durch eine schwere Gasaustauschstörung und bleibt eine Herausforderung für die moderne Intensivmedizin. Die häufigste Ursache für ein ARDS sind Pneumonien sowie eine Sepsis. Die Mortalität beträgt bei schwerem Verlauf bis zu 50 %. Die neue Definition des ARDS unterscheidet drei Schweregrade abhängig von der Schwere der Hypoxämie. Grundlage jeder Therapie ist die Behandlung der auslösenden Grunderkrankung. Die Beatmung erfolgt lungenprotektiv mit niedrigen Tidalvolumina und reduzierten Beatmungsdrücken. Eine intermittierende Bauchlagerung führt bei schwerem ARDS zu einer Mortalitätsreduktion. Extrakorporale Lungenunterstützungsverfahren können bei schwerstem, vital bedrohlichem Lungenversagen einen lebensnotwendigen Gasaustausch sichern, um Zeit für die Heilung der Lunge zu gewinnen und die Beatmungsaggressivität zu reduzieren.

Abstract

The acute respiratory distress syndrome (ARDS) is characterized by severe impairment of gas exchange and remains a challenge for modern intensive care medicine. The most common causes of ARDS are pneumonia and sepsis. The mortality in severe ARDS is as high as 50 %. The new definition of ARDS differentiates three levels of severity dependending on the degree of hypoxaemia. The fundamental basis of therapy is to treat the underlying cause of ARDS. Furthermore, lung protective mechanical ventilation must be applied using low tidal volumes and limiting inspiratory pressures. Intermittend prone positioning can reduce mortality in severe cases of ARDS. In extreme, life threatening cases extracorporeal membrane oxygenation can stabelize gas exchange and serve as a bridge to recovery and means to enable lung protective ventilation.

Schlüsselwörter

akutes Lungenversagen - ARDS - maschinelle Beatmung - Intensivmedizin

Keywords

acute respiratory distress syndrome - ARDS - mechanical ventilation - intensive care

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