Intensivtherapie in der Herzchirurgie – alles anders?

Jährlich werden in Deutschland ca. 100000 herzchirurgische Operationen [1] durchgeführt: Somit zählen diese zu den häufigsten mit einer Intensivtherapie verbundenen Eingriffen. Der Intensivaufenthalt kann sich aufgrund der Invasivität der Eingriffe, der mitunter schwerwiegenden Grunderkrankung und der häufigen Begleiterkrankungen der zunehmend älteren Patienten unter Umständen auch komplex gestalten.

Abstract

With approximately 100000 operations performed in Germany per year, cardiac surgery is among the surgical specialties that require intensive care tratment most frequently. Although all therapeutic aspects of ICU treatment are of high importance among cardiac surgery patients, there is a focus on hemodynamics with the overarching goal of sufficient oxygen delivery. Patients undergoing cardiac surgery are particularily prone to hemodynamic instability and low cardiac output syndrome, potentially culminating into cardiogenic shock. This article presents an overview of essential elements of intensive care medicine in cardiac surgery, paying special attention to hemodynamic monitoring, low cardiac output syndrome, inotropy, cardiac arrhyhmia, perioperative myocardial infarction, and patient blood management.

Kernaussagen

• Dieser Artikel gibt einen Überblick über die wesentlichen Elemente der Intensivmedizin in der Herzchirurgie.

• Der Schwerpunkt der Behandlung herzchirurgischer Patienten auf der Intensivstation liegt auf der Hämodynamik mit dem übergeordneten Ziel einer ausreichenden Sauerstoffzufuhr.

• Diese Patienten sind besonders anfällig für hämodynamische Instabilität und das Low Cardiac Output Syndrome (LCOS), das in einem kardiogenen Schock kulminieren kann.

• Das postoperative Vorhofflimmern (POAF) ist eine häufige Komplikation herzchirurgischer Eingriffe, die therapeutisch und prophylaktisch angegangen werden sollte.

• Das Risiko, im Rahmen einer herzchirurgischen Operation zu versterben, ist gering. Ein wesentlicher klinischer Morbiditäts- und Mortalitätsfaktor in diesem Zusammenhang ist die perioperative myokardiale Ischämie, die zu prognostizieren mit gewissen Unsicherheiten behaftet ist.

• Besonderes Augenmerk des Beitrags liegt auf der hämodynamischen Überwachung, dem LCOS, Inotropie, Herzrhythmusstörungen, dem perioperativen Myokardinfarkt und dem Patient Blood Management.

Schlüsselwörter

Herzchirurgie - hämodynamisches Monitoring - kardiogener Schock - Herzrhythmusstörungen - Myokardinfarkt - Patient Blood Management

Keywords

patient blood management - cardiac surgery - hemodynamic monitoring - cardiogenic shock - arrhythmias - myocardial infarction - intensive care medicine

Publication History

Article published online:
23 March 2023

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