Das aktute Abdomen auf der Intensivstation

Das akute Abdomen ist stets ein Notfall und erfordert eine umgehende Abklärung. Notwendig ist eine enge interdisziplinäre ärztliche und pflegerische Zusammenarbeit zwischen den beteiligten Fachabteilungen.

Kernaussagen

• Die Diagnose und die Therapie der Sepsis erfordern eine intensive und interdisziplinäre Zusammenarbeit zwischen allen beteiligten Fachabteilungen wie z. B. Intensivpflege, Anästhesisten, Chirurgen, Radiologen und Mikrobiologen.

• Das akute Abdomen in der Intensivtherapie erfordert zwingend eine unverzügliche Diagnostik und, falls notwendig, eine chirurgische Sanierung.

• Bei Anzeichen einer Sepsis muss frühzeitig mit der leitliniengerechten, antibiotischen und hämodynamischen Therapie begonnen werden. Antibiotic-Stewardship-Programme können zur differenzierten antibiotischen Behandlung beitragen.

• Patienten mit persistierend hohen postoperativen laborchemischen Entzündungswerten oder steigenden Entzündungswerten unter antibiotischer Therapie sollten frühzeitig einer Ursachendiagnostik mit Bildgebung (CT und Sonografie) und ggf. Exploration unterzogen werden.

• Die sekundäre Peritonitis ist eine häufige Ursache der Sepsis bei chirurgischen Patienten. Zuerst sollten daher operationsbedingte Komplikationen ausgeschlossen werden. Hierzu ist eine frühzeitige interdisziplinäre Kommunikation mit den beteiligten Chirurgen zur Fokussuche und Fokussanierung dringend gefordert.

• Die chirurgische Therapie zielt auf eine definitive Beseitigung der Sepsisursache mit primärem Bauchdeckenverschluss ab.

• Postoperativ ist der Patient auf ein abdominelles Kompartmentsyndrom oder eine persistierende Sepsis und Peritonitis zu überwachen. Mögliche Folgelaparotomien und Reexplorationen müssen frühzeitig eingeleitet werden.

Schlüsselwörter

Sepsis - Peritonitis - Darmischämie - Abszess - Fokussanierung - Infektiologie

Publication History

Article published online:
24 September 2024

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