Organersatzverfahren – So handeln Sie in der Akutphase

Abstract

Mechanische Organersatzverfahren finden eine immer weitere Verbreitung in der Intensivmedizin. Bei akutem Nieren-, Herz-Kreislauf- oder Lungenversagen können sie Zeit gewähren, bis das eigentliche Problem behoben ist. Trotzdem darf man nicht vergessen: Sie sind invasiv und komplikationsbehaftet. Dieser Beitrag gibt einen Überblick über die gängigsten Verfahren, ihre Indikationen und Limitationen sowie praktische Hinweise.

Kernaussagen

• Eine akute Nierenschädigung (AKI) tritt bei bis zu 70 % der kritisch kranken Patienten auf. Es handelt sich dabei um eine eigene Systemerkrankung.

• In erster Linie gilt es, ein AKI zu vermeiden, indem Risikopatienten identifiziert und Nephrotoxizität vermieden wird.

• Nierenersatzverfahren beruhen auf dem Prinzip der Hämodialyse, der Hämofiltration oder einer Kombination aus beiden (Hämodiafiltration). Sie lassen sich kontinuierlich oder intermittierend anwenden.

• Zu den Herz-Kreislauf- und Lungenunterstützungsverfahren gehören Extracorporeal Life Support (ECLS), Mechanical Circulatory Support (MCS), Left Ventricular Assist Device (LVAD), extrakorporale Membranoxygenierung (ECMO), Extra-Corporeal Cardiopulmonary Resuscitation (eCPR). Sie dienen der Überbrückung einer Organinsuffizienz und stellen keine definitive Therapie dar.

Schlüsselwörter:

mechanische Organersatzverfahren - akute Nierenschädigung - Herz-Kreislauf-Versagen - Lungenversagen - ECMO

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