ARDS-Diagnostik und -Therapie nach der Coronapandemie – alles beim Alten?

Die massiven wissenschaftlichen Aktivitäten zur Bewältigung der Coronapandemie haben für bestimmte intensivmedizinisch relevante Syndrome neue Blickwinkel und Perspektiven eröffnet. Neben der Sepsis betrifft dies das akute Lungenversagen als schwerste Manifestation der COVID-19-Infektion. In diesem Beitrag soll untersucht werden, ob sich daraus bereits neue Empfehlungen zur Diagnostik und Therapie des ARDS im Allgemeinen ableiten lassen.

Abstract

ARDS is a syndrome that can develop as a result of various underlying diseases. For a long time, the prevailing belief was that the course of the disease was comparable regardless of the underlying disease. However, even before the COVID-19 pandemic, it was suspected that there were different manifestations that could be treated more individually and thus reduce the high mortality rate of ARDS, which has remained unchanged for years. The various findings on the heterogeneity of the course of the disease in COVID-related ARDS appear to confirm these assumptions. It is therefore to be expected that the diagnosis and treatment of non-COVID-related ARDS will also have to be individualised according to such phenotypes in the future. However, as long as the effectiveness of such strategies has not been proven in clinical trials, the current recommendations for ARDS therapy will remain valid for the time being. However, the adjustments already formulated in this context to individual pathophysiological conditions with regard to respiratory mechanics, ventilation-perfusion distribution and possible cardiac dysfunction should be made more meticulously than has usually been the case to date.

Schlüsselwörter

akutes Lungenversagen - ARDS - COVID-19 - maschinelle Beatmung - Bauchlagerung - Phänotyp - Biomarker

Keywords

acute respiratory distress syndrome - mechanical ventilation - prone position - phenotype - biomarkers

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