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Aktuelle Konzepte des Polytraumamanagements: Von ATLS zu „Damage Control“

Current concepts of polytrauma management: from ATLS to “damage control”

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Zusammenfassung

In den letzten Jahren hat die Implementierung standardisierter Protokolle für das Management polytraumatisierter Patienten zu einer signifikanten Verbesserung der Traumaversorgung und zu einer Reduktion der posttraumatischen Sterblichkeit geführt. Das Advanced-Trauma-Life-Support- (ATLS-)Protokoll des American College of Surgeons wurde seit den 1990er Jahren in den meisten europäischen Ländern als „golden standard“ für die Akutversorgung schwerverletzter Patienten etabliert. Zu den weiterführenden Konzepten — über das ATLS-Programm hinaus — gehört der „Definitive-Surgical-Trauma-Care“- (DSTC)Kurs sowie das Konzept der „Damage control“ (Schadensbegrenzung) für schwerstverletzte Patienten mit akut lebensbedrohlichem Gesamtverletzungsmuster. Diese Phasen-orientierten diagnostischen und therapeutischen Strategien respektieren den Polytraumapatienten im gesamten Ausmaß der erlittenen Verletzungen und stehen in scharfem Kontrast zur klassischen Modalität der primären definitiven chirurgischen Versorgung (sog. „early total care“). Das „Damage control“-Konzept berücksichtigt hierbei die systemischen inflammatorischen und metabolischen Reaktionen des verletzten Organismus und ist auf das einzige primäre Ziel des Überlebens schwerstverletzter Patienten abgerichtet. Die vorliegende Arbeit soll eine Übersicht der aktuellen Konzepte des Polytraumamanagements anbieten, mit einem Fokus auf die Standardkonzepte von ATLS und „Damage control“.

Abstract

In recent years, the implementation of standardized protocols for polytrauma management has led to a significant improvement in trauma care as well as to a decrease in post-traumatic morbidity and mortality. As such, the “Advanced Trauma Life Support” (ATLS) protocol of the American College of Surgeons for the acute management of severely injured patients has been established as a gold standard in most European countries since the 1990s. Continuative concepts to the ATLS program include the “Definitive Surgical Trauma Care” (DSTC) algorithm and the concept of “damage control” surgery for polytraumatized patients with immediate life-threatening injuries. These phase-oriented therapeutic strategies appraise the injured patient of the whole extent of the sustained injuries and are in sharp contrast to previous modalities of “early total care” which advocate immediate definitive surgical intervention. The approach of “damage control” surgery takes into account the influence of systemic post-traumatic inflammatory and metabolic reactions of the organism and is aimed at reducing both the primary and the secondary, delayed, mortality in severely injured patients. The present paper provides an overview of the current state of management algorithms for polytrauma patients, with a focus on the standard concepts of ATLS and “damage control”.

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Danksagung

Die Autoren danken Frau Birgit Geiger (Verlag Urban & Vogel) für die Bewilligung zur partiellen deutschsprachigen Reproduktion des Artikels: Stahel PF, Heyde CE, Ertel W (2005) Current concepts of polytrauma management. Eur J Trauma 31: 200–211

Frau Anette Sommer (Graphikabteilung, Universitätsklinikum Benjamin Franklin, Berlin) gebührt Dank für die professionelle Unterstützung bei der Erstellung der Abbildungen.

Dr. Stahel wird durch die folgenden Sachbeihilfen der Deutschen Forschungsgemeinschaft (DFG) unterstützt: No. STA 635/1–1, STA 635/1–2, STA 635/2–1, TR 742/1–1.

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  1. Klinik für Unfall- und Wiederherstellungschirurgie, Charité — Universitätsmedizin Berlin, Campus Benjamin Franklin

    P. F. Stahel, C. E. Heyde, W. Wyrwich & W. Ertel

  2. Klinik für Unfall- und Wiederherstellungschirurgie, Charité, Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin

    P. F. Stahel

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Die Autoren P.F. Stahel und C.E. Heyde haben gleichwertig zu dieser Arbeit beigetragen. — Diese Übersichtsarbeit ist eine bewilligte partielle Replikation in deutscher Sprache des publizierten Artikels: P.F. Stahel, C.E. Heyde, W. Ertel (2005) Current concepts of polytrauma management. Eur J Trauma 31: 200–211. Die Reproduktion erfolgt mit Genehmigung des Verlages Urban & Vogel.

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Stahel, P.F., Heyde, C.E., Wyrwich, W. et al. Aktuelle Konzepte des Polytraumamanagements: Von ATLS zu „Damage Control“. Orthopäde 34, 823–836 (2005). https://doi.org/10.1007/s00132-005-0842-5

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