Pathophysiologie des akuten Lungenversagens (ARDS)

Das akute Atemnotsyndrom (ARDS) ist ein häufiges intensivmedizinisches Krankheitsbild. Die Pathophysiologie ist geprägt vom eingeschränkten Gasaustausch aufgrund einer Flüssigkeitsüberladung der Alveolen nach epi- und endothelialer Permeabilitätssteigerung und Leukozyten-Transmigration. Es resultieren Hypoxämie, Hyperkapnie sowie deletäre Konsequenzen für Makro- und Mikrozirkulation mit der Gefahr eines Multiorganversagens und hoher Mortalität.

Abstract

Acute respiratory distress syndrome (ARDS) is a common condition in intensive care medicine. Various intra- and extrapulmonal causes may trigger an epithelial and endothelial permeability increase, which leads to impaired gas exchange due to fluid overload of the alveoli and transmigration of leukocytes. This results in hypoxemia and hypercapnia, as well as deleterious consequences for the macro- and microcirculation with the risk of multi-organ failure and high mortality. This review summarizes ARDS pathophysiology and clinical consequences.

Kernaussagen

• Das ARDS ist ein äußerst heterogenes Syndrom. Verschiedene Entitäten münden in eine ähnliche pathophysiologische Kaskade.

• Das ARDS ist charakterisiert durch einen eingeschränkten Gasaustausch. Das grundlegende pathophysiologische Problem ist eine Schrankenstörung der alveolokapillären Barriere mit resultierendem alveolärem und interstitiellem Lungenödem.

• Inflammation, Zerstörung der Mikrozirkulation und beatmungsassoziierte Lungenschädigung unterhalten das Krankheitsbild.

• Die Entwicklung eines pulmonalarteriellen Hypertonus kann zu einem akuten Cor pulmonale mit deletären Konsequenzen für den Organismus führen.

• Im COVID-19-induzierten ARDS haben der Mechanismus der Inflammation und die Vaskulopathie mit Endothelopathie und Immunothrombose einen besonderen Stellenwert.

• Eine Fibrosierung der Lunge kann einer vollständigen Resolution des Krankheitsbildes entgegenstehen.

• Die Definition von verschiedenen ARDS-Phänotypen erlaubt zunehmend eine individualisiertere Behandlung. Als Beispiel sei Dexamethason beim COVID-19-induzierten ARDS genannt.

Schlüsselwörter

akutes Atemnotsyndrom - ARDS - akutes Lungenversagen - Gasaustausch - Intensivbehandlung - mechanische Beatmung

Keywords

mechanical ventilation - acute respiratory distress syndrome - gas exchange - critical illness

Publication History

Article published online:
08 January 2024

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