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Intensivmedizin up2date 2012; 08(03): 165-185
DOI: 10.1055/s-0032-1309875
Operative Intensivmedizin
© Georg Thieme Verlag KG Stuttgart · New York

Frühmobilisierung des chirurgischen Intensivpatienten

Sebastian Weiterer
,
Birgit Trierweiler-Hauke
,
Andreas Hecker
,
Gabor Szalay
,
Martin Heinrich
,
Konstantin Mayer
,
Markus A. Weigand
Further Information

Publication History

Publication Date:
13 August 2012 (online)

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Die Entwicklung einer generalisierten Muskelschwäche und die damit einhergehenden Funktionseinschränkungen sind ein essenzielles Problem von Intensivpatienten. Inaktivität, entzündliche Prozesse (Sepsis, ARDS) und auch Medikamente sind die wichtigsten Ursachen muskulärer Schwächen bei Intensivpatienten. Die Entstehung der Critical-illness-Myopathie und -Polyneuropathie ist komplex und beinhaltet metabolische, inflammatorische und bioenergetische Veränderungen. Für den Genesungsprozess und zur Wiederherstellung des funktionellen Status ist eine an den Zustand des Patienten angepasste Mobilisierung von großer Bedeutung.

Zur frühzeitigen Erkennung einer Muskelschwäche eignet sich die Handgriff-Dynamometrie als einfacheres objektives Mittel zur Messung der Handgriffstärke, welche Rückschlüsse auf die globale Kraft erlaubt. Auch bei beatmeten Patienten kann die Frühmobilisierung neuromuskulären Komplikationen vorbeugen. Um bei beatmeten Patienten die Belastung angepasst zu dosieren, sind neurophysiologische Tests wie die Elektromyografie und eine klinische Verlaufsbeobachtung (MRD-Score) hilfreich.

Bei Eingriffen an Oberbauchorganen muss man mit einem sympathischen Pleuraergusses rechnen. Eine intensive Mobilisierung erlaubt es, postoperative pulmonale Komplikationen nach Oberbaucheingriffen zu vermeiden. Die Möglichkeiten der Mobilisierung unfallchirurgischer Intensivpatienten hängt von der Art und dem Ausmaß der Verletzungen sowie der Stabilität der Osteosynthesen ab. Doch auch die individuellen Möglichkeiten des Patienten und dessen Begleiterkrankungen nehmen Einfluss auf seine Mobilisierung.

Der Einsatz von Medikamenten zur Therapie der Folgen einer längerfristigen Immobilisierung bedarf einer individuellen Nutzen-Risiko-Abwägung. Die elektrische Muskelstimulation ist eine Methode mit viel Potenzial und eine gut tolerierte Methode zur Prävention der Muskelatrophie.

Die Literatur zu diesem Beitrag finden Sie unterhttp://dx.doi.org/10.1055/s-0032-1309875.

 

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