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DOI: 10.1055/s-0042-113705
Organersatzverfahren – So handeln Sie in der Akutphase
Publikationsverlauf
Publikationsdatum:
16. September 2016 (online)
![](https://www.thieme-connect.de/media/legeartis/201604/lookinside/thumbnails/lege_04_2016_12_10-1055-s-0042-113705-1.jpg)
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
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Eine akute Nierenschädigung (AKI) tritt bei bis zu 70 % der kritisch kranken Patienten auf. Es handelt sich dabei um eine eigene Systemerkrankung.
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In erster Linie gilt es, ein AKI zu vermeiden, indem Risikopatienten identifiziert und Nephrotoxizität vermieden wird.
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Nierenersatzverfahren beruhen auf dem Prinzip der Hämodialyse, der Hämofiltration oder einer Kombination aus beiden (Hämodiafiltration). Sie lassen sich kontinuierlich oder intermittierend anwenden.
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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-
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