Intensivmedizinische Therapie von COVID-19

Die pathophysiologischen Abläufe des klassischen akuten Lungenversagens (ARDS) und des ARDS aufgrund einer SARS-CoV-2-Infektion (C-ARDS) sind grundsätzlich ähnlich. Beide führen in ihrer Endstrecke der Inflammation zu einer Störung der Blut-Luft-Schranke. Die Behandlungsstrategien für C-ARDS konzentrieren sich, wie beim klassischen ARDS, auf die Unterstützung oder den Ersatz von Organfunktionen und die Vermeidung von Folgeschäden. Der vorliegende Artikel fasst die Behandlungsstrategien auf der Intensivstation zusammen.

Abstract

The acute respiratory failure as well as ARDS (acute respiratory distress syndrome) have challenged clinicians since the initial description over 50 years ago. Various causes can lead to ARDS and therapeutic approaches for ARDS/ARF are limited to the support or replacement of organ functions and the prevention of therapy-induced consequences. In recent years, triggered by the SARS-CoV-2 pathogen, numerous cases of acute lung failure (C-ARDS) have emerged. The pathophysiological processes of classical ARDS and C-ARDS are essentially similar. In their final stages of inflammation, both lead to a disruption of the blood-air barrier. Treatment strategies for C-ARDS, like classical ARDS, focus on supporting or replacing organ functions and preventing consequential damage. This article summarizes the treatment strategies in the intensive care unit.

Kernaussagen

• Das klassische ARDS unter scheidet sich kaum in den grundlegenden pathophysiologischen Abläufen von dem ARDS, welches durch SARS-CoV-2 ausgelöst wird.

• Die Hyperinflammation ist ein wesentlicher Faktor in der Entstehung des ARDS.

• Die Therapie des ARDS besteht in einer Unterstützung der Organfunktion unter möglicher Vermeidung von Folgeschäden durch die Therapie.

• Eine antiinflammatorische Therapie mit Kortison sollte bei Sauerstoffpflichtigkeit durchgeführt werden.

• Bakterielle Ko-Infektionen sollten regelmäßig evaluiert und bei Relevanz adressiert werden, entsprechend den Leitlinien (ambulante und nosokomiale Pneumonie).

• Eine High-Flow-Sauerstofftherapie oder eine NIV können gegebenenfalls eine invasive Beatmung vermeiden.

• Bei Einleitung einer HFNC/NIV sollte ein Eskalationsschema festgelegt werden.

• Unter invasiver Beatmung ist das Ziel beim ARDS eine lungenprotektive Beatmung, mögliche additive Therapiestrategie ist die Bauchlage.

• Eine mögliche ECMO sollte bei Patienten mit ARDS frühzeitig diskutiert werden, um die Patientenselektion zu verbessern.

• Eine prophylaktische Antikoagulation sollte bei stationär behandelten Patienten mit COVID-19 durchgeführt werden, sofern keine Indikation für eine Vollantikoagulation besteht.

Schlüsselwörter

COVID-19 - ARDS - Intensivtherapie - akutes Lungenversagen

Keywords

COVID-19 - ARDS - intensive therapy - acute respiratory failure

Publication History

Article published online:
17 May 2024

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