Download PDF
Lege artis - Das Magazin zur ärztlichen Weiterbildung 2016; 6(04): 222-231
DOI: 10.1055/s-0042-113705
Fachwissen
Titelthema: Organersatzverfahren
© Georg Thieme Verlag Stuttgart · New York

Organersatzverfahren – So handeln Sie in der Akutphase

Arnim Geise
,
Michael Christ
Further Information

Publication History

Publication Date:
16 September 2016 (online)

Also available at
    Permissions and Reprints

Abstract

Mechanische Organersatzverfahren finden eine immer weitere Verbreitung in der Intensivmedizin. Bei akutem Nieren-, Herz-Kreislauf- oder Lungenversagen können sie Zeit gewähren, bis das eigentliche Problem behoben ist. Trotzdem darf man nicht vergessen: Sie sind invasiv und komplikationsbehaftet. Dieser Beitrag gibt einen Überblick über die gängigsten Verfahren, ihre Indikationen und Limitationen sowie praktische Hinweise.

Kernaussagen

  • Eine akute Nierenschädigung (AKI) tritt bei bis zu 70 % der kritisch kranken Patienten auf. Es handelt sich dabei um eine eigene Systemerkrankung.

  • In erster Linie gilt es, ein AKI zu vermeiden, indem Risikopatienten identifiziert und Nephrotoxizität vermieden wird.

  • Nierenersatzverfahren beruhen auf dem Prinzip der Hämodialyse, der Hämofiltration oder einer Kombination aus beiden (Hämodiafiltration). Sie lassen sich kontinuierlich oder intermittierend anwenden.

  • Zu den Herz-Kreislauf- und Lungenunterstützungsverfahren gehören Extracorporeal Life Support (ECLS), Mechanical Circulatory Support (MCS), Left Ventricular Assist Device (LVAD), extrakorporale Membranoxygenierung (ECMO), Extra-Corporeal Cardiopulmonary Resuscitation (eCPR). Sie dienen der Überbrückung einer Organinsuffizienz und stellen keine definitive Therapie dar.

Schlüsselwörter:

mechanische Organersatzverfahren - akute Nierenschädigung - Herz-Kreislauf-Versagen - Lungenversagen - ECMO

Ergänzendes Material

 

  • Literatur

  • 1 Drucker PF. Managing for Business Effectiveness. Harvard Business Review Im Internet: https://www.hbr.org/1963/05/managing-for-business-effectiveness Stand 01.07.2016 1963; 3: 53-60
    Google Scholar
  • 2 Kidney Disease Outcomes Quality Initiative KDIGO. Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl 2012; 2: 19-36
    CrossrefGoogle Scholar
  • 3 Im Internet: http://www.kidney-international.org Stand 01.07.2016
  • 4 Glodowski SD, Wagner G. New insights into the mechansims of acute kidney injury in the intensive care unit. J ClinAnesth 2015; 27: 175-180
    Google Scholar
  • 5 Brochard L, Abroug F, Brenner M et al. An Official ATS/ERS/ESICM/SCCM/SRLF Statement: Prevention and Management of Acute Renal Failure in the ICU Patient: an international consensus conference in intensive care medicine. Am J RespirCrit Care Med 2010; 181: 1128-1155
    CrossrefGoogle Scholar
  • 6 Payen D, Mateo J, Cavaillon JM et al. Impact of continuous venovenoushemofiltration on organ failure during the early phase of severe sepsis: a randomized controlled trial. Crit Care Med 2009; 37: 803-810
    CrossrefGoogle Scholar
  • 7 Karvellas CJ, Farhat MR, Sajjad I et al. A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury: a systematic review and meta-analysis. Crit Care 2011; 15
    Google Scholar
  • 8 Leite TT, Macedo E, Pereira SM et al. Timing of renal replacement therapy initiation by AKIN classification system. Crit Care 2013; 17
    Google Scholar
  • 9 Kielstein JT, Kretschmer U, Ernst T et al. Efficacy and cardiovascular tolerability of extended dialysis in critically ill patients: a randomized controlled study. Am J Kidney Dis 2004; 43: 342-349
    CrossrefGoogle Scholar
  • 10 Schwenger V, Weigand MA, Hoffmann O et al. Sustained low efficiency dialysis using a single-pass batch system in acute kidney injury - a randomized interventional trial: the Renal Replacement Therapy Study in Intensive Care Unit Patients. Crit Care 2012; 16
    Google Scholar
  • 11 Kidney Disease Outcomes Quality Initiative KDIGO. Clinical Practice Guidelines for Acute Kidney Injury. Kidney Int Suppl 2012; 2: 1-138
    CrossrefGoogle Scholar
  • 12 RENAL Replacement Therapy Study Investigators. Bellomo R, Cass A et al. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med 2009; 361: 1627-1638
    CrossrefPubMedGoogle Scholar
  • 13 Thiele H, Zeymer U, Neumann FJ et al. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012; 367: 1287-1296
    CrossrefGoogle Scholar
  • 14 Unverzagt S, Buerke M, de Waha A et al. Intra-aortic balloon pump counterpulsation (IABP) for myocardial infarction complicated by cardiogenic shock. Cochrane Database Syst Rev CD 007398 2015; 3
    Google Scholar
  • 15 Authors/Task Force members. Windecker S, Kolh P et al. ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 2014; 35: 2541-2619
    CrossrefPubMedGoogle Scholar
  • 16 Romeo F, Acconcia MC, Sergi D et al. Percutaneous assist devices in acute myocardial infarction with cardiogenic shock: Review, meta-analysis. World J Cardiol 2016; 8: 98-111
    CrossrefGoogle Scholar
  • 17 O'Neill WW, Kleiman NS, Moses J et al. A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study. Circulation 2012; 126: 1717-1727
    CrossrefGoogle Scholar
  • 18 Pichler P, Antretter H, Dünser M et al. Positionspapier der Österreichischen Kardiologischen Gesellschaft zum Einsatz der extrakorporalen Membranoxygenation (ECMO) bei erwachsenen kardiologischen Patienten. Wiener KlinischeWochenschrift 2015; 127: 169-184
    Google Scholar
  • 19 Paden ML, Rycus PT, Thiagarajan RR. Update and outcomes in extracorporeal life support. Seminars in Perinatology 2014; 38: 65-70
    CrossrefGoogle Scholar
  • 20 Zant R, Melter M, Doerfler C et al. Veno-arterial extracorporeal membrane oxygenation support for severe cardiac failure in a pediatric patient with intracranial hemorrhage after spontaneous aneurysmatic rupture. Perfusion 2016; 31: 255-257
    CrossrefGoogle Scholar
  • 21 Biscotti M, Gannon WD, Abrams D et al. Extracorporeal membrane oxygenation use in patients with traumatic brain injury. Perfusion 2015; 30: 407-409
    CrossrefGoogle Scholar
  • 22 Schmidt M, Tachon G, Devilliers C et al. Blood oxygenation and decarboxylation determinants during venovenous ECMO for respiratory failure in adults. Intensive Care Medicine 2013; 39: 838-846
    CrossrefGoogle Scholar
  • 23 Kredel M, Lubnow M, Westermaier T et al. Cerebral tissue oxygenation during the initiation of venovenous ECMO. ASAIO J 2014; 60: 694-700
    CrossrefGoogle Scholar
  • 24 Luyt CE, Bréchot N, Demondion P et al. Brain injury during venovenous extracorporeal membrane oxygenation. Intensive Care Med 2016; 42: 897-907
    CrossrefGoogle Scholar
  • 25 Thompson T, Wheeler A. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. NEJM 2000; 342: 1301-1308
    CrossrefGoogle Scholar
  • 26 Marhong JD, Munshi L, Detsky M et al. Mechanical ventilation during extracorporeal life support (ECLS): a systematic review. Intensive Care Med 2015; 41: 994-1003
    CrossrefGoogle Scholar
  • 27 Gattinoni L, Marini JJ, Pesenti A et al. The „baby lung“ became an adult. Intensive Care Med 2016; 42: 663-673
    CrossrefGoogle Scholar
  • 28 Fanelli V, Ranieri MV, Mancebo J et al. Feasibility and safety of low-flow extracorporeal carbon dioxide removal to facilitate ultra-protective ventilation in patients with moderate acute respiratory distress syndrome. Critical Care 2016; 20: 36-36
    CrossrefGoogle Scholar
  • 29 C. Aubron, AC Cheng, D. Pilcher et al. Infections acquired by adults who receive extracorporeal membrane oxygenation: risk factors and outcome. Infect Control HospEpidemiol 2013; 34: 24-30
    Google Scholar
  • 30 Soar J, Nolan J, Böttiger B et al. Erweiterte Reanimationsmaßnahmen für Erwachsene („adult advancedlifesupport“). NotfallRettungsmed 2015; 18: 770-770
    Google Scholar