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Acute Respiratory Distress Syndrome (ARDS)

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Sepsis und MODS

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Zusammenfassung

Die Berliner Definition des ARDS differenziert anhand des Schweregrades der Hypoxämie zwischen mildem (paO2/FiO2 <300), moderatem (<200) und schwerem (<100) ARDS. Die Beatmung kann eine beatmungsassoziierte Lungenschädigung verursachen. Die lungenprotektive Beatmung mit niedrigem VT (6 ml/kg standardisiert KG) ist daher heute Standard. Die Einstellung des PEEP-Wertes soll einen Kollaps der Lunge vermeiden; höhere PEEP-Werte werden bei Sepspispatienten mit moderatem bis schwerem ARDS und bei refraktärer Hypoxämie empfohlen. Die Bauchlage ist vorteilhaft und soll bei ausreichender Erfahrung des Zentrums angewendet werden. Der Vorteil des Rekrutierungsmanövers ist nicht belegt. Die Hochfrequenzoszillation zeigt keinen Effekt auf die Letalität bei höherem Risiko für Barotrauma und Hypotension. ARDS-Patienten sollten schnell von der Beatmung entwöhnt werden. Ein Entwöhnungsprotokoll in Kombination mit einem Sedierungsprotokoll reduziert die Langzeitletalität und ist daher Standard.

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  1. Klinik und Poliklinik für Anästhesie und Operative Intensivmedizin, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Straße 35, 53105, Bonn, Deutschland

    Univ.-Prof. Dr. med. C. Putensen

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  1. Univ.-Prof. Dr. med. C. Putensen
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  1. Department für Innere Medizin, Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle(Saale) der Martin-Luther-Universität Halle-Wittenberg, Halle(Saale), Germany

    Karl Werdan

  2. Lehrstuhl für Geriatrie, Charité-Universitätsmedizin Berlin und Evangelisches Geriatriezentrum Berlin gGmbH, Berlin, Berlin, Germany

    Ursula Müller-Werdan

  3. Hildesheim, Germany

    Hans-Peter Schuster

  4. Zentrum für Klinische Studien, Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Jena, Germany

    Frank M. Brunkhorst

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Putensen, C. (2016). Acute Respiratory Distress Syndrome (ARDS). In: Werdan, K., Müller-Werdan, U., Schuster, HP., Brunkhorst, F. (eds) Sepsis und MODS. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-45148-9_10

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