COVID-19: Intensivmedizinische Aspekte und Langzeitfolgen

Zusammenfassung

Etwa 14% der COVID-19-Patienten weisen einen schwereren und ca. 5% einen kritischen Krankheitsverlauf auf. Besonders gefährdet sind ältere Personen, männliches Geschlecht, Raucher und stark adipöse Menschen. Wird der Patient invasiv oder nichtinvasiv beatmet, so steigt die Mortalität auf 53% respektive 50% an. In der Regel beträgt die Dauer vom Beginn der Symptome bis zur Aufnahme auf die Intensivstation 10 Tage. Die mittlere Verweildauer auf der Intensivstation beträgt 9 Tage. Für die Priorisierung sind die klinische Erfolgsaussicht einer intensivmedizinischen Behandlung sowie der Wunsch des Patienten maßgebend. Zentrale Kriterien für die Aufnahme auf die Intensivstation sind eine Hypoxämie (SpO₂ < 90% unter 2 – 4 Liter Sauerstoff/min bei nicht vorbestehender Therapie), Dyspnoe, eine erhöhte Atemfrequenz (> 25 – 30/min) und ein systolischer Blutdruck ≤ 100 mmHg. Der Schutz des Personals genießt bei allen Maßnahmen Vorrang. Alle aerosolgenerierenden Prozeduren sollten nur mit großer Vorsicht erfolgen. Wird unter High Flow keine adäquate Oxygenierung erreicht (SpO₂ ≥ 90% oder ein paO₂ > 55 mmHg), sollte über eine Eskalation nachgedacht werden (NIV, invasive Beatmung). Die Patienten sollten lungenprotektiv beatmet werden. Die Intubation sollte als Rapid Sequence Induction erfolgen. Eine ECMO kann erwogen werden. Thrombembolische Komplikationen sind sehr häufig. Antibiotika sollten nicht routinemäßig gegeben werden. Die aktuell beste Datenlage liegt für Dexamethason vor. Remdesivir kann die Rekonvaleszenz beschleunigen. Langzeitfolgen nach COVID-19 sind sehr häufig. Kardiale, pulmonale und neurologische Probleme stehen dabei im Vordergrund.

Abstract

Approximately 14% of COVID-19 patients have a more severe and approximately 5% a critical course of disease. The elderly, males, smokers, and severely obese people are particularly at risk. If the patient is ventilated invasively or non-invasively, mortality rises to 53% and 50% respectively. As a rule, it takes ten days from the onset of symptoms to admission to the intensive care unit. The average length of stay in the intensive care unit is nine days. Prioritization is based on the clinical chances of success of intensive care treatment and the patientʼs wishes. Central criteria for admission to the intensive care unit are hypoxemia (SpO₂ < 90% by admitting 2 – 4 liters of oxygen/min., if no pre-existing therapy is used), dyspnea, an increased respiratory rate (> 25 – 30/min) and systolic blood pressure ≤ 100 mmHg. The protection of the personnel has priority in all measures. All aerosol generating procedures should be performed with great care. If adequate oxygenation is not achieved under high flow (SpO₂ ≥ 90% or a paO₂ > 55 mmHg), escalation should be considered (NIV, invasive ventilation). The patients should be ventilated lung-protectively. Intubation should be performed as rapid sequence induction. An ECMO can be considered. Thromboembolic complications are very frequent. Antibiotics should not be given routinely. The best data currently available is for dexamethasone. Remdesivir can accelerate the convalescence. Long-term consequences after COVID-19 are very common. Cardiac, pulmonary, and neurological problems are in the foreground.

Was ist wichtig?

Für die Intensivmedizin ist COVID-19 von großer Bedeutung. Wichtig sind dabei eine frühzeitige Priorisierung bei der Zuteilung der Kapazitäten, eine lungenprotektive Beatmung und mindestens prophylaktische Antikoagulation.

Die Langzeitfolgen umfassen vor allem kardiale, pulmonale und neurologische Symptome.

Schlüsselwörter

Langzeitfolgen - Intensivmedizin - COVID-19

Key words

intensive care - long-term effects - COVID-19

Publication History

Article published online:
14 December 2020

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