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Therapie des akuten Lungenversagens in einem Behandlungszentrum

Der Erfolg ist abhängig von der Indikationsstellung

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Zusammenfassung

Fragestellung

Trotz standardisierter Behandlung ist das akute Lungenversagen (ARDS) noch immer mit einer hohen Letalität behaftet. Dabei ist weit gehend unbekannt, durch welche Verlaufsparameter ein Ansprechen der Therapie gekennzeichnet ist und welche Patienten von einer erweiterten Therapie, einschließlich extrakorporaler Membranoxygenierung (ECMO), profitieren.

Methodik

In einer Anwendungsbeobachtung wurden die während der ersten 48 h erhobenen Beatmungs- und Vitalparameter von 93 Patienten analysiert, die einem Zentrum zur erweiterten Therapie des ARDS zugewiesen wurden.

Ergebnisse

Die Gesamtüberlebensrate betrug 70%; bei Patienten, die zusätzlich mit ECMO behandelt wurden, 67%. Patienten, die komorbiditätsbedingt eine relative Kontraindikation zur erweiterten Therapie des ARDS aufwiesen, hatten ein 4,7fach erhöhtes Risiko [95%-Konfidenzintervall (95%-CI): 3,3–24,9] des Nichtüberlebens, Patienten mit Multiorganversagen (MOV) ein 7,5fach erhöhtes Risiko (95%-CI: 2,3–25,2). Überlebende zeigten innerhalb der ersten 24 h eine signifikant ausgeprägtere Verbesserung der Oxygenierung (p<0,05) und der CO2-Elimination (p<0,05).

Schlussfolgerungen

Die erweiterte Therapie des ARDS, einschließlich ECMO, stellt eine therapeutische Option dar, wenn die gängigen Kontraindikationen beachtet werden. Eine Veränderung der Gasaustauschparameter, nicht aber ein bestimmter Wert per se, kann als prognostisches Kriterium für eine günstiges Ergebnis gewertet werden.

Abstract

Subject

Mortality rates remain high for the acute respiratory distress syndrome (ARDS) despite standardised treatment algorithms. Little is known about prognostic factors and exclusion criteria for advanced treatment including extracorporeal membrane oxygenation (ECMO).

Methods

In an observational study design a cohort of 93 patients with severe ARDS admitted to a referral centre were analysed according to ventilatory and vital parameters.

Results

Overall survival rate was 70% and in patients who received ECMO treatment it was 67%. In patients exhibiting relevant co-morbidity the odds ratio for fatal outcome increased to 4.7 (95% CI: 3.3–24.9), and patients with multiple organ failure had a 7.5-fold increase (95% CI: 2.3–25.2) for risk of death. Survivors demonstrated a more pronounced improvement in oxygenation (p<0.05) and CO2 removal (p<0.05) than non-survivors.

Conclusions

Advanced treatment of ARDS including ECMO represents a therapeutic option if none of the currently considered contraindications are present. An improvement in gas exchange parameters, but not a defined value per se may be useful as a prognostic factor for favourable outcome.

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Authors and Affiliations

  1. Klinik für Anästhesiologie, Universitätsklinikum Aachen

    D. Henzler, R. Dembinski, R. Kopp, R. Hawickhorst, R. Rossaint & R. Kuhlen

  2. Klinik für Anästhesiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen

    D. Henzler

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  1. D. Henzler
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  2. R. Dembinski
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  3. R. Kopp
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  4. R. Hawickhorst
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  5. R. Rossaint
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  6. R. Kuhlen
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Correspondence to D. Henzler.

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Henzler, D., Dembinski, R., Kopp, R. et al. Therapie des akuten Lungenversagens in einem Behandlungszentrum. Anaesthesist 53, 235–243 (2004). https://doi.org/10.1007/s00101-004-0653-9

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