Spezielle intensivmedizinische Behandlungskonzepte des schweren Thoraxtraumas

Nahezu die Hälfte (46,1%) aller Patienten mit schweren Verletzungen erleidet ein Thoraxtrauma, wobei in Deutschland stumpfe Verletzungsmechanismen (> 95%) deutlich überwiegen, meist als Folge von Verkehrsunfällen oder Stürzen [1]. Aufgrund der anatomischen Nähe verschiedener Organsysteme im Thorax ist das Verletzungsspektrum groß und die Differenzialdiagnostik wird durch ähnliche Leitsymptome erschwert.

Abstract

This review covers key elements of the critical care management of patients with thoracic trauma. Contrast-enhanced chest computertomography remains the diagnostic modality of choice, as it is more sensitive than conventional chest imaging. Regarding risk stratification, special caution is required in older patients with thoracic trauma given their high risk for posttraumatic complications. In the case of respiratory insufficiency, an attempt of non-invasive ventilation techniques is justified in most patients due to potential treatment benefits. Achieving sufficient pain control is a fundamental goal of critical care management. In this regard, erector-spinae-block and paravertebral block present potentially advantageous alternatives to thoracic epidural anaesthesia. In stable patients, the placement of small-calibre chest tubes may be a beneficial approach compared with large-bore tubes. If surgical stabilization of rib fractures is indicated, it should be done as early as possible.

Kernaussagen

• Ältere Patienten mit einem Thoraxtrauma sind besonders durch Komplikationen gefährdet.

• Bei den meisten Patienten ist im Fall einer respiratorischen Insuffizienz ein Therapieversuch mit nicht invasiver Beatmung (NIV) oder High-Flow-Sauerstoff aufgrund potenzieller Behandlungsvorteile gerechtfertigt.

• Das Erreichen einer suffizienten Analgesie ist wesentliches Ziel der intensivmedizinischen Maßnahmen. Hierzu stellen die Erector-spinae-Blockade und die Paravertebralblockade potenziell vorteilhafte Alternativen zur PDA dar.

• Sofern eine operative Stabilisierung von Rippenfrakturen angestrebt wird, sollte diese möglichst frühzeitig erfolgen.

Schlüsselwörter

Thoraxtrauma - nicht invasive Beatmung - Lungenkontusion - Regionalanästhesie - Rippenstabilisierung

Keywords

chest trauma - noninvasive ventilation - lung contusion - regional anaesthesia - rib fixation

Publication History

Article published online:
24 June 2024

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