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DOI: 10.1055/s-0030-1270554
© Georg Thieme Verlag Stuttgart · New York
Akutes Nierenversagen bei Brandverletzten – Ursachen, Konsequenzen und Vermeidungstrategien
Acute renale failure in burns – causes, consequences and avoidance strategiesPublikationsverlauf
Publikationsdatum:
17. Januar 2011 (online)
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Zusammenfassung
Das akute Nierenversagen stellt eine häufige und bedrohliche Komplikation in der Intensivmedizin dar. Gerade brandverletzte Patienten haben durch das thermische Trauma und durch die damit verbundenen Veränderungen (z.B. Verbrennungskrankheit) ein hohes Risiko für die Entwicklung eines ANV. Aber auch andere Faktoren, wie z.B. therapeutische Interventionen und Flüssigkeitsersatz spielen eine wichtige Rolle. Durch das Entstehen eines ANV wird die Morbidität und Mortalität des Brandverletzten noch zusätzlich erhöht. Die vorliegende Übersichtsarbeit soll die Ursachen und Konsequenzen dieser schwerwiegenden Komplikation aufzeigen und auf Strategien zur Vermeidung des ANV beim kritisch brandverletzten Patienten eingehen.
Abstract
Acute renal failure (ARF) is a common and dangerous complication in intensive care medicine. Especially critical ill patients, who are suffering from major burns, have a high risk to develop ARF as a consequence of their trauma. Many factors, including the trauma itself, the damage of soft tissue and consecutive rhabdomyolysis, the development of the burn illness and therapeutic interventions play also a major role in this context. These circumstances have a major impact on the morbidity and mortality of severely burned patients. The aim of this manuscript is to review the reasons for the development of an ARF in burn patients as well as its consequences; moreover it highlights potential strategies to avoid ARF in critically ill burned patients.
Schlüsselwörter:
Akutes Nierenversagen - Brandverletzung - patientenadaptiertes Flüssigkeitsregime - Prävention des ANV
Keywords
acute renal failure - burns - volume management - prevention of ARF
Kernaussagen
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Die Verbrennungskrankheit ist ein komplexes Zustandsbild und tritt bereits kurz nach dem Trauma auf.
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Schwerbrandverletzte Patienten sind nicht nur durch das Trauma selbst, sondern auch durch die Folgen der Verbrennungskrankheit bedroht.
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Eine schwerwiegende Komplikation in der Therapie brandverletzter Patienten stellt das akute Nierenversagen dar.
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Das akute Nierenversagen verschlechtert die Prognose von brandverletzten Patienten deutlich.
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Massive Flüssigkeitszufuhr kann Komplikationen wie erhöhten intraabdominellen Druck und in weiterer Folge ein akutes Nierenversagen auslösen.
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Durch gezielte patientenadaptierte Therapie und ein hämodynamisches Monitoring kann Infusionsvolumen eingespart werden.
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Dr. med. Stefan A Palma
Prof. Dr. Philipp Metnitz
Priv.-Doz. Dr. Lars-Peter Kamolz
Prof. Manfred Frey
Prof. Wilfred Druml
eMail: stefan.palma@meduniwien.ac.at
eMail: philipp.metnitz@meduniwien.ac.at
eMail: lars-peter.kamolz@meduniwien.ac.at
eMail: manfred.frey@meduniwien.ac.at
eMail: wilfred.druml@meduniwien.ac.at