Zusammenfassung
Die Intensivmedizin vereint Ärzte, Pflegende und viele andere im medizinischen Bereich tätigen Berufsgruppen zu einem Team bei der Behandlung von Patienten, deren Vitalfunktion in lebensbedrohlicher Weise gestört oder gefährdet sind. Neben der kontinuierlichen Überwachung, die gewissermaßen den kleinsten gemeinsamen Nenner aller Formen der Intensivmedizin darstellt, kommt bei der Intensivtherapie noch die kontinuierliche Behandlung gestörter Organfunktionen hinzu, ebenso die kontinuierliche intensive Pflege. Die Komplexität der Intensivmedizin spricht gegen eine Verselbständigung zu einem eigenen Fachgebiet, dennoch ist die Koordination durch einen erfahrenen Intensivmediziner von herausragender Bedeutung. Die augenblickliche Situation der Intensivmedizin ist gekennzeichnet durch ein zunehmendes Spannungsfeld zwischen immer mehr faszinierenden medizinischen Möglichkeiten (z. B. passagerer Herzersatz, Leberersatzverfahren, medikamentöse Therapie der Sepsis, Vermeidung von Behandlungsschäden oder Komplikationen der „Critical Illness”) einerseits und limitierten Budgets andererseits. Reflektiert wird dieser Spannungsbogen von zwei Grundängsten in der Bevölkerung: zum einen, dass aus Kostengründen nicht alles medizinisch Machbare getan wird, zum anderen, dass in der Intensivmedizin am Lebensende zuviel getan wird. Vor diesem Hintergrund nehmen die ethischen Fragestellungen an die Intensivmedizin zu, auf allen Ebenen des Gesundheitssystems.
Abstract
Physicians, nurses and many other allied health professions join in intensive care as a team for the treatment of patients whose vital functions are either endangered or impaired. Apart from continuous monitoring, which represents the smallest common denominator of all types of intensive-care treatment, intensive-care therapy also encompasses continuous treatment and support of failing organ functions and likewise continuous intensive nursing. The complexity of intensive-care medicine is a strong argument against intensive-care becoming a medical specialty of its own. Nevertheless, the coordination of intensive care-medicine by an experienced intensive care physician is of utmost importance. The present situation in intensive-care medicine is characterised by an increasing tension between new and fascinating medical possibilities (such as right and left ventricular assistance device systems, liver support, pharmacologic treatment of sepsis, avoidance of the complications of critical illness) on the one hand, and limited budgets on the other hand. This conflict is reflected by two basic fears within the population: firstly, the fear that not everything medically possible is being done for the patient due to economic reasons, secondly, a fear of futile treatment at the end of life, merely prolonging inevitable death. Accordingly, ethical questions regarding intensive-care are emerging at all levels of the health system.
Schlüsselwörter
Intensivtherapie - Intensivmedizin - Intensivstation - Ethik - Ökonomie
Key words
Intensive-care medicine - intensive-care unit - ethics - economy
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Univ.-Prof. Dr. med. Hugo Van Aken, FRCA, FANZCA
Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Münster
Albert-Schweitzer-Straße 33
48149 Münster
