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Evidenzbasierte Intensivtherapie des erhöhten intrakraniellen Drucks nach Schädel-Hirn-Trauma

Evidence-based intensive care treatment of intracranial hypertension after traumatic brain injury

  • Intensivmedizin
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Zusammenfassung

Das Schädel-Hirn-Trauma (SHT) ist eine häufige Erkrankung mit einer ungünstigen Prognose. So kommt es nach einem schweren SHT in mehr als 40% der Fälle zu schwer wiegenden Behinderungen oder zum Tod. Es ist das vorrangige Ziel der Behandlung dieser Patienten, das Ausmaß der sekundären Hirnschädigung zu minimieren. Dabei ist die Therapie des erhöhten intrakraniellen Drucks („intracranial pressure“, ICP) von zentraler Bedeutung. Neben den chirurgischen Behandlungsoptionen existieren verschiedene konservative intensivmedizinische Therapieansätze. Dazu gehören die Behandlung mit Osmodiuretika, Barbituraten oder Kortikosteroiden, die Hyperventilation und die Induktion einer therapeutischen Hypothermie. Im Rahmen dieser Übersicht werden diese Therapieansätze und die Ziele einer hirndrucksenkenden Behandlung von Patienten nach einem SHT unter Verwendung evidenzbasierter Kriterien bewertet und Empfehlungen für die klinische Praxis formuliert.

Abstract

Traumatic brain injury (TBI) occurs frequently and is associated with a poor prognosis. Severe TBI results in substantial disability or death in more than 40% of cases. The major aim of treatment of these patients is to minimize secondary brain injury and in this respect, the prevention of intracranial hypertension plays a key role. In addition to surgical approaches, various conservative treatment options exist, such as the use of osmodiuretics, barbiturates, or corticosteroids, hyperventilation as well as induced therapeutic hypothermia. This review analyzes these treatment options and the therapeutic goals of lowering intracranial pressure (ICP) in patients after TBI using evidence-based criteria, and provides recommendations for clinical practice.

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  1. Anaesthesiologische Universitätsklinik, Universitätsklinikum Freiburg

    B. H. J. Pannen & T. Loop

  2. Anaesthesiologische Universitätsklinik, Universitätsklinikum Freiburg, Hugstetter Straße 55, 79106, Freiburg

    B. H. J. Pannen

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  1. B. H. J. Pannen
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  2. T. Loop
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Correspondence to B. H. J. Pannen.

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Pannen, B.H.J., Loop, T. Evidenzbasierte Intensivtherapie des erhöhten intrakraniellen Drucks nach Schädel-Hirn-Trauma. Anaesthesist 54, 127–136 (2005). https://doi.org/10.1007/s00101-004-0785-y

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