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Intensivmedizin up2date 2016; 12(01): 57-68
DOI: 10.1055/s-0041-106671
Neuro-Intensivmedizin
© Georg Thieme Verlag KG Stuttgart · New York

Besonderheiten neurochirurgischer Intensivpatienten

Christopher Beynon
,
Andreas W. Unterberg
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Publication Date:
11 February 2016 (online)

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Kernaussagen

  • Vorrangiges Ziel der Behandlung neurochirurgischer Intensivpatienten ist die Protektion vitalen Hirngewebes. Hierfür sind eine adäquate Therapie aller Organsysteme und oft eine interdisziplinäre Behandlung essenziell.

  • Das wichtigste Instrument der Überwachung ist die regelmäßige klinisch-neurologische Untersuchung, um bei einer Verschlechterung sofort und adäquat handeln zu können. Sind Patienten neurologisch nicht suffizient zu beurteilen, werden apparative Untersuchungen notwendig. Hierbei hat insbesondere die CT einen herausragenden Stellenwert.

  • Die Überwachung des intrakraniellen Drucks ist insbesondere bei komatösen Patienten indiziert, um eine intrakranielle Hypertension frühzeitig erkennen und behandeln zu können. Invasive Sonden ermöglichen das Erkennen von Ischämien als Risikofaktor für die Entstehung sekundärer Hirnschäden.

  • Schädigungen des zentralen Nervensystems können Störungen verschiedener Organsysteme verursachen. Hormonelle Entgleisungen können beispielsweise zu schweren Hyper- und Hyponatriämien führen und kardiale Dysfunktionen verursachen. Auch bei der Behandlung pulmonaler Störungen oder Infektionen sind Besonderheiten bei neurochirurgischen Intensivpatienten zu beachten.

 

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