Akute respiratorische Insuffizienz bei schwerer Lungenschädigung – ARDS und ALI

Zusammenfassung

Das Acute-Respiratory-Distress-Syndrom (ARDS) als schwerste Form des akuten Lungenschadens (acute lung injury – ALI) wurde mit der frühen Entwicklung der Intensiv- und Beatmungsmedizin als eigene Krankheitsentität beschrieben. In den 4 Jahrzehnten seit der Erstbeschreibung wuchs das Wissen über Ätiologie, Physiologie, Histologie und Epidemiologie dieser oft tödlichen pulmonalen Komplikation einer schweren akuten Erkrankung wie Pneumonie oder Sepsis. Die wesentlichen therapeutischen Fortschritte waren anfänglich nur durch die Verbesserung der intensivmedizinischen Methoden und Überwachungssysteme zu erreichen. Die große ARDS-Network-Studie zur Höhe des Atemzugsvolumens unter Beatmung zeigte dann eindrucksvoll, dass gezielte klinische Studien auch beim ARDS durchführbar sind und wesentliche Erkenntnisse liefern. Diese Studie, wie auch nachfolgende große ARDS-Studien, haben entscheidend die Beatmungstherapie verändert und zu therapeutischen Konzepten geführt, die die Prognose der Erkrankung verbessern. Eine zunehmend standardisierte Versorgung der ARDS-Patienten mit innovativen Therapieverfahren wie extrakorporale Gasaustauschssysteme werden zu einer weiteren Verbesserung der Therapiemöglichkeiten dieses schweren Krankheitsbildes führen. Die moderne Pneumologie ist hier im besonderen Maße gefordert und kann aufgrund der breiten Erfahrung in allen Bereichen der Erkrankungen der Atmungsorgane einen wesentlichen Beitrag liefern.

Abstract

As a consequence of the novel therapeutic option of mechanical ventilation in early intensive care medicine, the acute respiratory distress syndrome (ARDS) was defined as a disease entity of its own representing the most severe form of acute lung injury (ALI). Since its first description four decades ago, our knowledge about the aetiology, physiology, histology and epidemiology of this lethal pulmonary complication of severe acute diseases such as pneumonia or sepsis has been increasing steadily. The initial major therapeutic advances were due to improvements in intensive care medical procedures and monitoring. The large ARDS Network clinical trial on the magnitude of tidal volume impressively demonstrated the feasibility of targeted clinical trials in patients with ARDS that provide robust evidence in this field. This clinical trial, as well as following large-scale trials in ARDS patients, led to significant changes of ventilation therapy and therapeutic strategies that improve the outcome of this disease entity. Advances in the standardisation of care for ARDS patients involving innovative therapeutic procedures such as extracorporeal gas exchange systems will lead to a further improvement in ARDS management and outcome. Modern pulmonary medicine can play a pivotal role in this process and can contribute its rich experiences in all areas of the respiratory system.

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