Zusammenfassung
Im Rahmen dieser Übersicht werden einige wesentliche Aspekte des Langzeitüberlebens
und der Morbidität von ehemaligen Intensivpatienten dargestellt. Das Langzeitüberleben
von Patienten nach Intensivtherapie ist im Wesentlichen vom Abbau der physiologischen
Reserven durch die Akuterkrankung und von fortschreitenden Grunderkrankungen abhängig.
Hohes Alter beeinflusst vor allem die kurzfristige Mortalität innerhalb der ersten
30 Tage, während ein septisches Mehrorganversagen die Sterblichkeit über Jahre beeinflussen
kann. Im Weiteren wird dargestellt, warum ehemalige Intensivpatienten oft viele Monate
über eine reduzierte körperliche Leistungsfähigkeit klagen und welche neuropsychologischen
Konsequenzen eine kritische Erkrankung und deren Behandlung haben kann. Ein weiteres
Kapitel beschäftigt sich mit den sozioökonomischen Belastungen von Patienten und
ihren Angehörigen. Die strukturiert erfasste gesundheitsbezogene Lebensqualität als
klinischer Endpunkt der Ergebnisqualität intensivmedizinischer Leistungen gewinnt
zunehmend an Bedeutung, indirekte Ansätze, die Lebensqualität zu erfassen, gehen mehr
auf den Lebenswunsch ehemaliger Intensivpatienten in ihrem jeweiligen Gesundheitszustand
ein. Während bisherige Nachsorgestudien die Probleme ehemaliger Intensivpatienten
meist rein deskriptiv erfasst haben, sollte ein zukünftiger Forschungsschwerpunkt
in der Aufdeckung kausaler Beziehungen zwischen intensivmedizinischer Behandlung und
nachintensivstationärer Morbidität liegen. Hierdurch könnte die Qualität des Überlebens
nachhaltig verbessert werden.
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PD Dr. med. Markus Wehler
Medizinische Klinik I mit Poliklinik der Universität Erlangen-Nürnberg
Ulmenweg 18
91054 Erlangen
Email: markus.wehler@med1.imed.uni-erlangen.de
