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Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54(02): 108-127
DOI: 10.1055/a-0664-5700
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Georg Thieme Verlag KG Stuttgart · New York

Lungensonografie für Anästhesie, Intensiv- und Notfallmedizin

Lung Ultrasound for Anesthesia, Intensive Care and Emergency Medicine
Wolf Armbruster
,
Rüdiger Eichholz
,
Thomas Notheisen
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Publication History

Publication Date:
15 February 2019 (online)

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Zusammenfassung

Die Lungensonografie ist in der Intensiv- und Notfallmedizin ein unterschätztes Werkzeug: Bei bestimmten klinischen Fragestellungen ist ihre Sensitivität drastisch höher als die der Röntgen-Thoraxuntersuchung [1]. Ein standardisierter Untersuchungsgang verbessert dabei die Untersuchungsqualität [2]. Dieser Artikel vermittelt Grundlagenwissen der Lungensonografie und stellt die Überlegenheit des Ultraschalls gegenüber Röntgenverfahren heraus.

Abstract

Lung ultrasound is an underrated tool in preclinical emergency situations, intensive care units, ORs and emergency rooms. For certain clinical questions, there is a drastically higher sensitivity in comparison to chest X-ray examinations (sensitivity in pneumothorax diagnostics 86 vs. 28%, specificity 97 vs. 100%. A standardized examination improves the quality of the ultrasound examination and thus the diagnostic value. The article provides basic information on pulmonary ultrasound and aims to highlight the superiority of ultrasound over x-ray procedures for anesthesia, intensive care and emergency medicine in accordance to the international evidence-based recommendations for point of care ultrasound. Finally, we added a checklist for the “post-interventional exclusion of pneumothorax” and a checklist for the “diagnosis of dyspnea by sonography”.

Kernaussagen

  • Lungenultraschall ist der Standard in der Lungendiagnostik [5], [9], [10], [54], [57].

  • Es werden zu häufig unkritische Röntgenuntersuchungen angeordnet, die keine relevante Fragestellung und Aussagekraft besitzen. Bei diesen steht schon während der Indikationsstellung fest, dass sie keine therapeutischen Konsequenzen haben [39], [58].

  • Laut Strahlenschutzgesetz erfordert die rechtfertigende Indikation immer die Feststellung, dass beim Röntgen der gesundheitliche Nutzen der Anwendung am Menschen gegenüber dem Strahlenrisiko überwiegt. Andere Verfahren ohne Strahlenexposition sind bei der Abwägung zu berücksichtigen.

  • Ultraschalluntersuchungen sind bei der Fragestellung Pneumothorax-Ausschluss, interstitielles Ödem, Konsolidierung und Pleuraerguss dem konventionellen Röntgen überlegen und der CT ebenbürtig [3], [59], [60].

  • Die Kontrolle des Therapieverlaufs sollte bei Lungenödem, Pleuraerguss, Pneumonie und ARDS mit Ultraschall erfolgen [3].

  • Die Lungendiagnostik ist zur Ermittlung des Therapieerfolges bei Herzinsuffizienz und bei Dialysepatienten zielführend [25], [61].

  • Durch den vermehrten Einsatz von Ultraschall können Patienten vor unnötiger Strahlung bewahrt sowie Therapieverzögerungen und Transporte von Risikopatienten zu Röntgenuntersuchungen vermieden werden [2], [38], [58].

  • Mit dem Grundlagenwissen und der geübten Anwendung der Untersuchung von Lungengleiten, B-Linien, Konsolidierung und Pleuraerguss kann in nahezu 90% der Patienten mit Dyspnoe eine initial korrekte Diagnose gestellt werden [10].

Schlüsselwörter

Lungensonografie - Pneumothorax-Ausschluss - pleurale freie Flüssigkeit - Lungenödem - Lungenkonsolidierung

Key words

lung ultrasound - exclusion pneumothorax - pleural free fluid - lung edema - lung consolidation
 

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