Intensivmedizinische Herausforderungen nach Operationen mit Herz-Lungen-Maschine

Herzoperationen unter Einsatz der Herz-Lungen-Maschine sind mit erheblichen pathophysiologischen Veränderungen verbunden. Die postoperative intensivmedizinische Betreuung erfordert ein fundiertes Verständnis der komplexen Pathophysiologie sowie möglicher Komplikationen und eine gute Zusammenarbeit zwischen Herzchirurgie, Intensivmedizin, Kardioanästhesie und Kardiotechnik.

Kernaussagen

• Die Herz-Lungen-Maschine (HLM) ersetzt temporär Herz- und Lungenfunktion, führt jedoch durch Blutkontakt mit Luft und künstlichen Oberflächen zu Entzündungsreaktionen, Gerinnungsstörungen und Mikrozirkulationsstörungen, die den postoperativen Verlauf mitbestimmen.

• Das rasche Erkennen und Behandeln typischer herzchirurgischer Komplikationen ist eine der wichtigsten Aufgaben der Intensivmedizin nach Operationen an der HLM.

• Fundierte Kenntnisse in der Beurteilung der Hämodynamik und in der Echokardiografie (TTE und TEE) sind unabdingbare Skills.

• ERAS-Konzepte (Enhanced Recovery After Surgery), bereits intraoperative multimodale Analgesie und angepasste Sedation sind essenziell für eine frühzeitige Extubation und einen kurzen Aufenthalt auf der Intensivstation.

• Die herzchirurgische Intensivmedizin ist eine Teamaufgabe. Nur durch eine optimale Zusammenarbeit und aufeinander abgestimmte Therapiekonzepte zwischen Herzchirurgie, Kardioanästhesie, Kardiotechnik, Intensivpflege und Intensivmedizin kann ein optimales Outcome der Patienten sichergestellt werden.

Schlüsselwörter

Herzlungenmaschine - herzchirurgische Intensivmedizin - hämodynamisches Management - herzchirurgische Komplikationen

Publication History

Article published online:
13 February 2026

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