Überleben nach der Intensivtherapie

Zusammenfassung

Im Rahmen dieser Übersicht werden einige wesentliche Aspekte des Langzeitüberlebens und der Morbidität von ehemaligen Intensivpatienten dargestellt. Das Langzeitüberleben von Patienten nach Intensivtherapie ist im Wesentlichen vom Abbau der physiologischen Reserven durch die Akuterkrankung und von fortschreitenden Grunderkrankungen abhängig. Hohes Alter beeinflusst vor allem die kurzfristige Mortalität innerhalb der ersten 30 Tage, während ein septisches Mehrorganversagen die Sterblichkeit über Jahre beeinflussen kann. Im Weiteren wird dargestellt, warum ehemalige Intensivpatienten oft viele Monate über eine reduzierte körperliche Leistungsfähigkeit klagen und welche neuropsychologischen Konsequenzen eine kritische Erkrankung und deren Behandlung haben kann. Ein weiteres Kapitel beschäftigt sich mit den sozioökonomischen Be­lastungen von Patienten und ihren Angehörigen. Die strukturiert erfasste gesundheitsbezogene Lebensqualität als klinischer Endpunkt der Ergebnisqualität intensivmedizinischer Leistungen gewinnt zunehmend an Bedeutung, indirekte Ansätze, die Lebensqualität zu erfassen, gehen mehr auf den Lebenswunsch ehemaliger Intensivpatienten in ihrem jeweiligen Gesundheitszustand ein. Während bisherige Nachsorgestudien die Probleme ehemaliger Intensivpatienten meist rein deskriptiv erfasst haben, sollte ein zukünftiger Forschungsschwerpunkt in der Aufdeckung kausaler Beziehungen zwischen intensivmedizinischer Behandlung und nachintensivstationärer Morbidität liegen. Hierdurch könnte die Qualität des Überlebens nachhaltig verbessert werden.

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