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Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53(02): 102-111
DOI: 10.1055/s-0043-107166
Topthema
CME-Fortbildung
Georg Thieme Verlag KG Stuttgart · New York

ARDS – Ein Update – Teil 1: Epidemiologie, Pathophysiologie und Diagnostik

ARDS – An Update – Part 1: Epidemiology, Pathophysiology and Diagnosis
Rolf Dembinski
,
Frank Mielck
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Publikationsverlauf

Publikationsdatum:
09. Februar 2018 (online)

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Zusammenfassung

Das akute Lungenversagen (Acute respiratory Distress Syndrome, ARDS) ist inzwischen seit mehr als 50 Jahren als schwerwiegende Komplikation unterschiedlicher Grunderkrankungen gefürchtet [1]. Häufig leiden ARDS-Patienten langfristig unter schwerwiegenden Beeinträchtigungen – auch nach primär erfolgreicher Therapie. Der erste Teil dieses Updates gibt einen aktualisierten Überblick zu Definition, Epidemiologie und Pathophysiologie des ARDS.

Abstract

The Acute Respiratory Distress Syndrome (ARDS) is defined by hypoxemic respiratory failure caused by inflammatory response within the lung usually requiring invasive mechanical ventilation. Despite more than 50 years of research numerous issues regarding epidemiology, pathophysiology and diagnosis remain unclear until today: Due to rather unspecific clinical diagnostic criteria incidence of ARDS varies considerably in clinical trials with a range from 4 to 79 cases per 100 000 persons per year. Consequently, mortality is also highly variable from about 40 to 60% in severe ARDS. Pathophysiology is mainly characterized by granulocyte infiltration of the lung thereby inducing interstitial and intra-alveolar lung edema with surfactant depletion and atelectasis formation. However, it is unknown whether pulmonary and extrapulmonary causes and risk factors for ARDS are accompanied by different pathophysiologic processes due to primary endothelial and epithelial injury. Thus, possible benefits of corresponding biomarker panels for the differentiation of endothelial and epithelial lung injury are also speculative until today. Therefore, ARDS diagnosis is still based on clinical findings and radiological imaging.

Kernaussagen

  • Das akute Lungenversagen ist ein klinisch definiertes Syndrom unterschiedlicher Genese.

  • Aufgrund der unspezifischen Definitionskriterien variieren epidemiologische Angaben zum Teil erheblich: So rangiert die Inzidenz zwischen 4 und 79 Fällen pro 100000 Einwohner und Jahr, während die Letalität etwa zwischen 40 und 60% liegt.

  • Die Pathophysiologie ist durch eine granulozytäre Inflammationsreaktion in der Lunge mit nachfolgendem interstitiellem und intraalveolärem Lungenödem mit Surfactant-Mangel und Atelektasenbildung gekennzeichnet.

  • Inwieweit auslösende Faktoren entsprechend ihrem primär endothelialen oder epithelialen Schädigungsmechanismus den pathophysiologischen Prozess und den Krankheitsverlauf beeinflussen, ist bis heute ungeklärt.

  • Noch sind keine Biomarker zur Diagnose oder spezifischen Therapie etabliert.

  • Die Diagnostik fußt auf klinischen Befunden und radiologischer Bildgebung.

Schlüsselwörter

akute respiratorische Insuffizienz - Hypoxämie - Inflammation - Inzidenz - Letalität

Key words

acute respiratory failure - hypoxemia - inflammation - incidence - mortality
 

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