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Intensivmedizin up2date 2006; 2(3): 257-267
DOI: 10.1055/s-2006-944660
Notfallmedizin
© Georg Thieme Verlag KG Stuttgart · New York

Therapeutische Hypothermie in der Intensivmedizin

Oliver  Kimberger, Andreas  Kliegel, Erik  Popp
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Publication Date:
30 August 2006 (online)

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Kernaussagen

Die schlechte Prognose von Patienten nach Herz-Kreislauf-Stillstand wird neben dem unmittelbaren hypoxischen Neuronenuntergang vor allem durch Schäden in der Reperfusionsphase verursacht. Die therapeutisch induzierte milde Hypothermie (32-34 °C für 12-24 Stunden) kann die Entstehung vieler Vorgänge, die zu diesen Sekundärschädigungen führen, verhindern oder zumindest reduzieren. Die Prognose nach Herzstillstand kann durch die milde Hypothermie deutlich verbessert werden.

Ob nicht-invasive oder invasive Kühlmethoden angewendet werden, ist für die Effektivität der Hypothermie unerheblich. Je schneller die Zieltemperatur erreicht werden kann, desto größer ist wahrscheinlich der neuroprotektive Effekt.

Die therapeutische milde Hypothermie kann jedoch ebenso wie die unbeabsichtigte perioperative Hypothermie unerwünschte Nebenwirkungen haben. Zu den wichtigsten potenziellen Problemen zählen die Beeinträchtigung der Gerinnung, Wundheilungsstörungen und Wundinfektionen sowie kardiale Komplikationen. Dennoch wird die Anwendung der therapeutischen milden Hypothermie bei komatösen Patienten nach Herz-Kreislauf-Stillstand in den Leitlinien des European Resuscitation Councils (ERC) ausdrücklich empfohlen.

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Dr. med. Erik Popp

Klinik für Anaesthesiologie

Universitätsklinikum Heidelberg · Im Neuenheimer Feld 110 · 69120 Heidelberg

Phone: 0 62 21/5 63 63 70

Fax: 0 62 21/62 51 85 66 43

Email: erik.popp@uni-heidelberg.de