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Fast Track in der Thoraxchirurgie

Fast track in thoracic surgery

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Zusammenfassung

Patienten, die sich thoraxchirurgischen Eingriffen unterziehen, sind v.a. durch pulmonale Komplikationen wie Pneumonie und Atelektase gefährdet. Je nach Alter, präoperativer FEV1 (forcierte exspiratorische Ein-Sekunden-Kapazität), Operationsdauer und Resektionsausmaß wird in der Literatur die Morbidität mit bis zu 42%, die Mortalität mit bis zu 7% angegeben. Fast Track in der Thoraxchirurgie zielt auf Reduktion der pulmonalen Komplikationsrate und der Mortalität nach resezierenden Lungeneingriffen, speziell bei Patienten mit präoperativ reduzierter FEV1. Dies soll durch spezifische Maßnahmen im prä-, intra- und postoperativen Bereich geschehen. Wesentliche Fast-Track-Elemente in der Thoraxchirurgie sind Nikotinverzicht, Atemtherapie, Nahrungsergänzung, hohe thorakale Periduralanästhesie, Flüssigkeitsrestriktion, frühe Mobilisation und früher Kostaufbau. Die Wirksamkeit dieser Einzelmaßnahmen wurde bereits dokumentiert, allerdings gibt es noch wenig Evidenz, welchen Vorteil die Kombination dieser Maßnahmen im Sinne eines multimodalen Fast-Track-Konzeptes bietet; insbesondere sollte noch genauer charakterisiert werden, welche Patienten von solchen Konzepten profitieren.

Abstract

Patients undergoing thoracic surgery are threatened by pulmonary complications such as pneumonia and atelectasis. Age, preoperative FEV1, operative time and extent of resection are predictors for adverse outcome. Reported morbidity after lung resection is as high as 42% and mortality up to 7%. Fast track in thoracic surgery aims at reducing morbidity and mortality rates after lung resection by introducing specific measures into the pre-, intra- and postoperative periods. Basic fast track elements in thoracic surgery are smoking cessation, preoperative physiotherapy, micronutrient supplementation, high thoracic epidural anesthesia, fluid restriction, early mobilization and enteral feeding. The effectiveness of these individual measures has been proven of value in perioperative care, however, evidence on multimodal therapy regimens in thoracic surgery is limited. In particular it remains to be elucidated which patients should be fast tracked in order to improve outcomes.

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  1. Klinik für Thorax- und Gefäßchirurgie, Universität Ulm, Steinhövelstraße 9, 89075, Ulm, Deutschland

    B. Mühling, K.H. Orend & L. Sunder-Plassmann

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  1. B. Mühling
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  2. K.H. Orend
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  3. L. Sunder-Plassmann
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Correspondence to B. Mühling.

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Mühling, B., Orend, K. & Sunder-Plassmann, L. Fast Track in der Thoraxchirurgie. Chirurg 80, 706–710 (2009). https://doi.org/10.1007/s00104-009-1678-z

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