Behandlungsprinzipien in der herzchirurgischen Intensivmedizin

Ein interdisziplinär eng abgestimmtes Handeln von Chirurgen, Kardioanästhesisten, Kardiotechnikern und Intensivmedizinern ist für das Outcome herzchirurgischer Patienten nach wie vor elementar. Diese Übersichtsarbeit fokussiert sich auf grundsätzliche Pathomechanismen und Behandlungsprinzipien der perioperativen herzchirurgischen Intensivmedizin und möchte damit als „Amuse-Gueule“ für den Herzchirurgie-affinen Intensivmediziner verstanden werden.

Kernaussagen

• In der akuten postoperativen Phase nach herzchirurgischen Eingriffen wird die Hämodynamik durch ein passageres Kapillarlecksyndrom und einen vorübergehend gesteigerten Flüssigkeitsbedarf bestimmt.

• Typische zu erwartenden Komplikationen nach herzchirurgischen Operationen sind die Koagulopathie, die Arrhythmie und der Reperfusionsschaden.

• Nach dem Ausgleich der Hypothermie muss unter Aufrechterhaltung der Mikrozirkulation, bei stabilisiertem Elektrolyt- und Säure-Basen-Haushalt die frühzeitige Entwöhnung von der Analgosedierung und der maschinellen Beatmung höchste Priorität auf der Intensivstation haben.

• Typischerweise endet die systemische Inflammation innerhalb der ersten 24 Stunden nach dem operativen Eingriff, und dies ermöglicht nachfolgend einen sukzessiven, aber moderaten Flüssigkeitsentzug im Rahmen der weiteren intensivmedizinischen Behandlung.

• Ein interdisziplinär abgestimmtes Behandlungskonzept von Operateuren, Anästhesisten, Kardiotechnikern, Physio- und Ergotherapeuten, spezialisierter Intensivpflege und Intensivmedizinern ist für das Outcome des herzchirurgischen Patienten entscheidend.

Schlüsselwörter

herzchirurgische Intensivmedizin - Hämodynamik - Vorlast - Nachlast - Beatmungsmanagement

Publication History

Article published online:
28 May 2020

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