Aktuelle Aspekte der intensivmedizinischen Versorgung bei Schädel-Hirn-Trauma – Teil 2

Das Schädel-Hirn-Trauma ist ein komplexes Krankheitsbild mit hoher Mortalität. In Teil 1 dieses Beitrags wurden primäre Behandlungsstrategien, hämodynamisches Management und multimodales Monitoring behandelt [1], Teil 2 fokussiert nun sekundäre Behandlungsstrategien, Langzeitergebnis, Neuroprognostik und Chronifizierung.

Abstract

This two-part article deals with the intensive medical care of traumatic brain injury. Part 1 addresses the primary treatment strategy, haemodynamic management and multimodal monitoring, Part 2 secondary treatment strategies, long-term outcome, neuroprognostics and chronification. Traumatic brain injury is a complex clinical entity with a high mortality rate. The primary aim is to maintain homeostasis based on physiological targeted values. In addition, further therapy must be geared towards intracranial pressure. In addition to this, there are other monitoring options that appear sensible from a pathophysiological point of view with appropriate therapy adjustment. However, there is still a lack of data on their effectiveness. A further aspect is the inflammation of the cerebrum with the “cross-talk” of the organs, which has a significant influence on further intensive medical care.

Kernaussagen

• Beatmungsziel ist primär Normoxie und Normokapnie.

• Bei einer Hyponatriämie muss zwischen einem zerebralen Salzverlustsyndrom und einem Syndrom der inadäquaten ADH-Sekretion differenziert werden.

• Die Ernährung sollte wenn möglich enteral erfolgen.

• SHT-Patienten weisen oftmals eine Dysphagie auf.

• Unter Berücksichtigung von Hirndruck und Nachblutungsrisiko hat eine Frühmobilisation positive Auswirkungen auf den Genesungsverlauf.

• Etwa ein Drittel der SHT-Patienten entwickelt eine disseminierte intravasale Koagulation.

• Zur Thromboseprophylaxe sollte, solange eine Antikoagulation nicht möglich ist, eine pneumatische Beinvenenkompression zum Einsatz kommen.

• Neuroprognostik sollte im interdisziplinären Behandlungsteam unter Würdigung aller relevanten Befunde erfolgen.

Schlüsselwörter

Schädel-Hirn-Trauma - sekundäre Behandlungsstrategie - Hämodynamik - multimodales Monitoring - Beatmung - Ernährung - Frührehabilitation

Keywords

traumatic brain injury - secondary treatment strategy - haemodynamic management - multimodal monitoring - ventilation - nutrition - early rehabilitation

Publication History

Article published online:
29 July 2024

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