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Intensivmedizin up2date 2020; 16(02): 151-159
DOI: 10.1055/a-1150-1559
Allgemeine Intensivmedizin

SARS-CoV-2/COVID-19: Empfehlungen zu Diagnostik und Therapie

SARS CoV-2/COVID-19: Evidence-Based Recommendation on Diagnosis and Therapy
Berthold Bein
,
Martin Bachmann
,
Susanne Huggett
,
Petra Wegermann
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Zusammenfassung

Der Übersichtsartikel ist als praktische Handreichung für alle gedacht, die COVID-19-Patienten behandeln bzw. in nächster Zeit behandeln werden, und fasst das derzeit verfügbare Wissen zu Diagnostik und Therapie zusammen. Zusätzlich werden auch neue und experimentelle Therapien bewertet, soweit dazu zumindest Einzelfallberichte vorliegen.

Abstract

COVID-19, a new viral disease affecting primarily the respiratory system and the lung, has caused a pandemic with serious challenges to health systems around the world. In about 20% of patients, severe symptoms occur after a mean incubation period of 5 – 6 days; 5% of patients need intensive care therapy. Morbidity is about 1 – 2%. Protecting health care workers is of paramount importance in order to prevent hospital acquired infections. Therefore, during all procedures associated with aerosol production, a personal safety equipment consisting of a FFP2/FFP3 (N95) respiratory mask, gloves, safety glasses and a waterproof overall should be used. Therapy is based on established recommendations issued for patients with acute lung injury (ARDS). Lung protective ventilation, prone position, restrictive fluid management and an adequate management of organ failures are the mainstays of therapy. In case of fulminant lung failure, veno-venous extracorporeal membrane oxygenation may be used as a rescue in experienced centres. New, experimental therapies evolve with ever increasing frequency; currently, however, there is no evidence based recommendation possible. If off-label and compassionate use of these drugs is considered, an individual benefit-risk assessment is necessary, since serious side effects have been reported.

Kernaussagen

  • COVID-19 ist eine neuartige virale Erkrankung, die die Atemwege befällt. Aktuell verfügbare Daten legen nahe, dass es in ca. 20% der Fälle es zu einem schwereren Krankheitsverlauf kommt, der in ca. 5% aller Fälle auch intensivmedizinische Maßnahmen erforderlich macht. Die Letalität beträgt zwischen 1 und 2% aller Erkrankten.

  • Eigenschutz des Personals ist essenziell, um eine nosokomiale Infektion zu vermeiden. Bei allen Aerosol produzierenden Maßnahmen ist daher eine Schutzausrüstung mit FFP2/FFP3-Maske, Schutzbrille und flüssigkeitsdichtem Kittel zu tragen.

  • Die Therapie intensivpflichtiger Patienten mit Lungenversagen basiert auf den etablierten Empfehlungen der Fachgesellschaften zur Behandlung von Patienten mit ARDS. Lungenprotektive Ventilation, Lagerungstherapie, restriktive Flüssigkeitsgabe und adäquate Beherrschung weiterer Organinsuffizienzen stehen hier im Mittelpunkt. Wenn eine Behandlung mittels extrakorporaler Membranoxygenierung nötig ist, sollte die Behandlung in erfahrenen Zentren durchgeführt werden.

  • Neue und experimentelle Therapieoptionen mit unterschiedlichsten Angriffspunkten werden zunehmend diskutiert; evidenzbasiert kann für keine dieser Therapien derzeit eine Empfehlung ausgesprochen werden. In jedem Fall ist vor Verwendung einer Substanz als Off-Label Use eine individuelle Nutzen-Risiko-Abwägung erforderlich, da auch die jeweiligen Nebenwirkungen beachtet werden müssen.

Schlüsselwörter

SARS CoV-2 - COVID-19 - Intensivtherapie - ARDS - akutes Lungenversagen - persönliche Schutzausrüstung - FFP3

Key words

SARS CoV-2 - COVID-19 - critical care - adult respiratory distress syndrome - acute lung injury - personal protection equipment - N95 respiratory masks


Publication History

Article published online:
28 May 2020

Georg Thieme Verlag KG
Stuttgart · New York

 

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