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Der chronisch kritisch kranke Patient aus der Perspektive des Hämatoonkologen

Chronic critically ill patients from the perspective of hematologists/oncologists

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Zusammenfassung

Etliche Faktoren machen kritisch kranke Patienten mit hämatologischer oder onkologischer Grunderkrankung zu einem besonderen Kollektiv auf der Intensivstation: eine häufig nicht oder zumindest fraglich „heilbare“ Grunderkrankung, therapieassoziierte Komplikationen sowie wie eine häufig bestehende Immunsuppression. Die Prognose dieser Patienten hat sich in den vergangenen Jahren deutlich verbessert, sodass sich eine grundsätzliche Zurückhaltung bei der Entscheidung, diese Patienten auf einer Intensivstation zu behandeln, definitiv nicht mehr rechtfertigen lässt. Eine umfassende infektiologische Diagnostik sowie eine leitliniengerechte, sowohl kausale als auch supportive Behandlung können die Prognose einer Sepsis auch bei hämatoonkologischen Patienten verbessern. In der Therapie des respiratorischen Versagens kommt der nichtinvasiven Beatmung ein hoher Stellenwert zur Reduktion der Mortalität zu, wenn sie früh einsetzt und Kontraindikationen sowie Abbruchskriterien berücksichtigt werden. Überlegungen zu Langzeitprognose, Lebensqualität und Palliation werden zunehmend auch zu intensivmedizinischen Themen.

Abstract

Many factors contribute to making critically ill patients with underlying hematological or oncological diseases into a special collective on intensive care units, such as an often incurable or at least doubtfully curable underlying disease, therapy associated complications and a commonly present immunosuppression. The prognosis of these patients has clearly improved in recent years so that a general reluctance in deciding to treat these patients in intensive care units can no longer be justified. Comprehensive infection diagnostics and a guideline oriented causal and supportive treatment can improve the prognosis of sepsis even in hematology/oncology patients. In the therapy of respiratory failure non-invasive ventilation is of great importance for a reduction in mortality if used early and contraindications, such as termination criteria are considered. Considerations on long-term prognosis, quality of life and palliative care are increasingly becoming topics in intensive care medicine.

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  1. Universitätsklinik für Innere Medizin I, Intensivstation 13.i2, Medizinische Universität Wien, Allgemeines Krankenhaus der Stadt Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich

    T. Staudinger & P. Schellongowski

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  2. P. Schellongowski
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Staudinger, T., Schellongowski, P. Der chronisch kritisch kranke Patient aus der Perspektive des Hämatoonkologen. Med Klin Intensivmed Notfmed 108, 295–302 (2013). https://doi.org/10.1007/s00063-012-0196-9

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