ARDS-Diagnostik und -Therapie nach der Coronapandemie – alles beim Alten?

Die massiven wissenschaftlichen Aktivitäten zur Bewältigung der Coronapandemie haben für bestimmte intensivmedizinisch relevante Syndrome neue Blickwinkel und Perspektiven eröffnet. Neben der Sepsis betrifft dies das akute Lungenversagen als schwerste Manifestation der COVID-19-Infektion. In diesem Beitrag soll untersucht werden, ob sich daraus bereits neue Empfehlungen zur Diagnostik und Therapie des ARDS im Allgemeinen ableiten lassen.

Abstract

ARDS is a syndrome that can develop as a result of various underlying diseases. For a long time, the prevailing belief was that the course of the disease was comparable regardless of the underlying disease. However, even before the COVID-19 pandemic, it was suspected that there were different manifestations that could be treated more individually and thus reduce the high mortality rate of ARDS, which has remained unchanged for years. The various findings on the heterogeneity of the course of the disease in COVID-related ARDS appear to confirm these assumptions. It is therefore to be expected that the diagnosis and treatment of non-COVID-related ARDS will also have to be individualised according to such phenotypes in the future. However, as long as the effectiveness of such strategies has not been proven in clinical trials, the current recommendations for ARDS therapy will remain valid for the time being. However, the adjustments already formulated in this context to individual pathophysiological conditions with regard to respiratory mechanics, ventilation-perfusion distribution and possible cardiac dysfunction should be made more meticulously than has usually been the case to date.

Kernaussagen

• Die Letalität des ARDS bleibt trotz Beachtung der aktuellen Therapieempfehlungen unverändert.

• Bereits vor der COVID-19-Pandemie zeichnete sich ab, dass die Differenzierung des ARDS in verschiedene Phänotypen zusätzliche Therapieoptionen zulassen könnte. Insbesondere die Unterscheidung zwischen hyper- und hypoinflammatorischen Verläufen schien in dieser Hinsicht erfolgversprechend.

• Die im Rahmen der COVID-Pandemie gewonnenen Erkenntnisse zu heterogenen Krankheitsverläufen und entsprechend individualisierten Therapiestrategien lassen sich mit dieser Annahme in Einklang bringen.

• Es erscheint daher auch beim nicht COVID-bedingten ARDS sinnvoll, Subgruppen mit unterschiedlicher Krankheitsausprägung zu identifizieren.

• Die Steuerung einer entsprechend individualisierten Therapie mithilfe von Biomarkern ist dabei vielversprechend.

Schlüsselwörter

akutes Lungenversagen - ARDS - COVID-19 - maschinelle Beatmung - Bauchlagerung - Phänotyp - Biomarker

Keywords

acute respiratory distress syndrome - mechanical ventilation - prone position - phenotype - biomarkers

Publication History

Article published online:
08 January 2024

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