Zusammenfassung
Die Prognose neurointensivpflichtiger Patienten hängt wesentlich von neuronalen Sekundärschäden ab, bei denen verschiedene Mechanismen, wie Ödembildung oder intrakranielle Drucksteigerung, zu einem ischämischen/hypoxischen Gewebeuntergang führen. Durch den zerebralen Schaden, aber auch durch die Notwendigkeit der Analgosedierung sind diese Patienten klinisch meist nur eingeschränkt beurteilbar, zudem sind Zeichen eines Sekundärschadens häufig bereits Ausdruck eines fortgeschrittenen Herniationssyndroms und kennzeichnen damit ein meist unumkehrbares Geschehen. Zur frühzeitigen Vorhersage und Detektion von Sekundärschäden sind in den letzten Jahren zahlreiche Überwachungstechniken entwickelt worden, die bettseitig und möglichst kontinuierlich Informationen über den Status verschiedener zerebraler Funktionssysteme liefern. Dieses Neuromonitoring kommt zum Einsatz, um rechtzeitig therapeutische Maßnahmen einleiten zu können, deren Effekt zu überprüfen, eine prognostische Einschätzung vorzunehmen und schließlich das langfristige neurologische Ergebnis des Patienten zu verbessern. Häufig werden verschiedene Monitoringtechniken zu einem multimodalen Neuromonitoring kombiniert. Die vorliegende Arbeit gibt eine Übersicht der wichtigsten gegenwärtig verfügbaren und angewendeten Neuromonitoringverfahren.
Abstract
The prognosis of neurointensive care patients depends largely on the occurrence of secondary ischemic/hypoxic tissue damage, which is mediated by different pathomechanisms, such as edema formation or increased intracranial pressure. Due to the cerebral damage and need for sedation as well as intubation, clinical assessment of these patients is limited. Furthermore, clinical signs of secondary damage, such as advanced herniation syndromes are often delayed and therefore mostly indicate irreversible brain damage. To adequately predict and detect secondary neuronal damage, various neuromonitoring techniques have been developed in recent years with ongoing technical refinement. These can be used for bedside and ideally continuous monitoring of various functional systems of the brain. Neuromonitoring is used to implement early therapeutic measures before irreversible brain damage has occurred, to monitor therapeutic effects, for evaluation of the prognosis and to improve the neurological outcome of patients. Different monitoring techniques are often combined in multimodal neuromonitoring. This article gives an overview of the most promising neuromonitoring techniques available.
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Dohmen, C., Sakowitz, O. Multimodales Monitoring in der Neurointensivmedizin. Nervenarzt 83, 1559–1568 (2012). https://doi.org/10.1007/s00115-012-3530-9
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DOI: https://doi.org/10.1007/s00115-012-3530-9