Skip to main content
SpringerLink
Log in

Prophylaxe und Therapie der akuten respiratorischen Insuffizienz und des ARDS

  • Chapter
Intensivtherapie bei Sepsis und Multiorganversagen

  • 19 Accesses

Zusammenfassung

Vor mehr als 25 Jahren wurde erstmalig auf eine besondere Form der akuten respiratorischen Insuffizienz aufmerksam gemacht [2, 64], die seitdem unter verschiedenen Bezeichnungen („Schocklunge“, „adult respiratory distress Syndrome“ (ARDS), „akutes Lungenversagen“, in der Intensivmedizin eine erhebliche Bedeutung spielt. Diese akute respiratorische Insuffizienz beruht auf einer schweren diffusen Schädigung des Lungenparenchyms. Sie ist funktionell gekennzeichnet durch:

  1. 1)

    arterielle Hypoxämie unterschiedlichen Schweregrades,

  2. 2)

    diffuse röntgenologische Infiltration,

  3. 3)

    verminderte Dehnbarkeit (Compliance) der Lunge.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 54.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Similar content being viewed by others

Literatur

  1. Artigas A (1988) Adult respiratory distress syndrome: Changing concepts of clinical evaluation and recovery. In: Vincent JL (ed) Update in intensive care and emergency medicine, 5. Springer, Berlin Heidelberg New York Tokyo, pp 97–114

    Google Scholar 

  2. Asbaugh DG, Bigelow DB, Petty TL, Levine BE (1967) Acute respiratory distress in adults. Lancet 2: 319–323

    Article  Google Scholar 

  3. Baker SP, O’Neill B (1976) The injury severity score: An update. J Trauma 16: 882–885

    Google Scholar 

  4. Baum M, Benzer H, Mutz N, Pauser G, Toncar L (1980) Inversed Ratio Ventilation (IRV). Die Rolle des Atemzeitverhältnisses in der Beatmung beim ARDS. Anaesthesist 29: 592596

    Google Scholar 

  5. Baum M, Benzer H, Putensen C, Koller W, Putz G (1989) Biphasic Positive Airway Pressure ( BiPAP) - eine neue Form der augmentierenden Beatmung. Anaesthesist 38: 452–458

    Google Scholar 

  6. Benzer H (1991) Therapie der respiratorischen Insuffizienz. In: Kilian J, Benzer H, Ahnefeld FW (eds) Grundzüge der Beatmung: Springer, Berlin Heidelberg New York Tokyo (Klinische Anästesiologie und Intensivmedizin, Bd 39, S 215–278 )

    Google Scholar 

  7. Benzer H, Koller W (1987) Die Strategie der Beatmung. Intensivmedizin 24: 214–219

    Google Scholar 

  8. Bolton C, Gilbert JJ, Hahn AF, Sibbald WJ (1984) Polyneuropathy in critically ill patients. J Neurol Neurosurg Psychiatry 47: 1223–1231

    Article  PubMed  CAS  Google Scholar 

  9. Bone RC, Fisher CJ, Clemmer TP, Slotman GJ, Metz CA, Balk RA, and the Methylprednisolone Severe Sepsis Study Group (1987) A controlled clinical trial of high-dose methylprednisolone in the treatment of severe sepsis and septic shock. N Engl J Med 317: 653–658

    Article  Google Scholar 

  10. Border JR, Hasset J, LaDuca J, Seibel R, Steinberg S, Mills B, Losi P, Border D (1987) The gut origin septic states in blunt multiple trauma (ISS - 40) in the ICU. Ann Surg 206: 427448

    Google Scholar 

  11. Braschi A, lotti G (1989) Partial ventilatory support in 1989. Intens Care Med 15: 488–490

    Article  CAS  Google Scholar 

  12. Brochard L, Pluskwa F, Lemaire F (1987) Improved efficacy of spontaneous breathing with inspiratory pressure support. Am Rev Respir Dis 136: 411–415

    Article  PubMed  CAS  Google Scholar 

  13. Burchardi H, Sydow M, Crozier TA, Burgdorff J (1990) Organversagen bei Polytraumapatienten–Einfluß einer frühen Osteosynthese von Frakturen auf Komplikationen. Anästh Intensivther Notfallmed 25: 64–71

    Article  PubMed  CAS  Google Scholar 

  14. Cameron JS (1990) Acute renal failure in the ICU: The nephrologist’s view. In: Bihari D, Neild G (eds) Acute renal failure in the intensive therapy unit. Springer, Berlin Heidelberg Now York Tokyo, pp 3–11

    Chapter  Google Scholar 

  15. Carrico CJ, Meakins JL, Marshall JC, Fry D, Maier RV (1986) Multiple-organ-failure syndrome. Arch Surg 121: 196–208

    Article  PubMed  CAS  Google Scholar 

  16. Cerra FB (1989) Is there a role for nutritional support in gastrointestinal surgery? In: Najarian JS (ed) Progress in gastrointestinal surgery. Year Book Medical Publishers, Chicago, pp 388–394

    Google Scholar 

  17. Dalen R van (1991) Selective decontamination in ICU patients: benefits and doubts. In: Vincent JL (ed) Update in intensive care and emergency medicine, 14. Springer, Berlin Heidelberg New York Tokyo, pp 379–386

    Google Scholar 

  18. Dantzker DR, Brook CJ, Dehart P, Lynch JP, Weg JG (1979) Ventilation-perfusion distributions in the adult respiratory distress syndrome. Am Rev Respir Dis 120: 10391052

    Google Scholar 

  19. DeCamp MM, Demling RH (1988) Posttraumatic multisystem organ failure. J Am Med Assoc 260: 530–534

    Article  Google Scholar 

  20. Dreyfuss D, Saumon G (1992) Barotrauma is volutrauma, but which volume is the one responsible? Intensive Care Med 18: 39–41

    Article  Google Scholar 

  21. Dyck P (1989) Hypoxic neuropathy: Does hypoxia play a role in diabetic neuropathy? The 1988 Wartenberg lecture. Neurology 39: 111–118

    Article  PubMed  CAS  Google Scholar 

  22. Faist E, Baue AE, Dittmer H, Heberer G (1983) Multiple organ failure in polytrauma patients. J Trauma 23: 775–787

    Article  PubMed  CAS  Google Scholar 

  23. Falke JK (1988) Intermittent mandatory ventilation: revisited. In: Vincent JL (ed) Update in intensive care and emergency medicine, 5. Springer, Berlin Heidelberg New York Tokyo, pp 759–766

    Google Scholar 

  24. Falke K, Rossaint R, Pison U, Slama K, Lopez P, Santak B, Zapol WM (1991) Inhaled nitric oxide selectively reduces pulmonary hypertension in severe ARDS and improves gas exchange as well as as right heart ejection fraction. Am Rev Respir Dis 143 [Suppl]: A248

    Google Scholar 

  25. Fong Y, Marano MA, Barber A, He W, Moldawer LL, Bushman ED, Coyle SM, Shires GT, Lowry SF (1989) Total parenteral nutrition and bowel rest modify the metabolic response to endotoxin in humans. Ann Surg 210: 449–547

    Article  PubMed  CAS  Google Scholar 

  26. Frostell C, Fratacci MD, Wain JC, Jones R, Zapol WM (1991) Inhaled nitric oxide. A selective pulmonary vasodilator reversing hypoxic pulmonary vasoconstriction. Circulation 83: 2038–2047

    Google Scholar 

  27. Garbe G, Sydow M (1990) Selektive Dekontamination des Tractus Digestivus–Eine neuartige Infektionstherapie. Krankenhauspharmazie 11: 233–238

    Google Scholar 

  28. Gattinoni L, Pesenti A, Mascheroni D, et al. (1986) Low-frequency positive-pressure ventilation with extracorporeal CO2-removal in severe acute respiratory failure. J Am Med Assoc 256: 881–886

    Article  CAS  Google Scholar 

  29. Gattinoni L, Pesenti A, Avalli L, Rossi F, Bombino M (1987) Pressure-volume curve of total respiratory system in acute respiratory failure. Am Rev Respir Dis 136: 730–736

    Article  PubMed  CAS  Google Scholar 

  30. Gattinoni L, Pesenti A, Bombino M et al. (1988) Relationships between lung computed tomography density, gas exchange, and PEEP in acute respiratory failure. Anesthesiology 69: 824–832

    Article  PubMed  CAS  Google Scholar 

  31. Gattinoni L, Pelosi P, Vitale G, Pesenti A, D’Andrea L, Mascheroni D (1991) Body position changes redistribute lung computed-tomographic density in patients with acute respiratory failure. Anesthesiology 74: 15–23

    Article  PubMed  CAS  Google Scholar 

  32. Gerstner G, Grunberger W (1980) Dopamine treatment for prevention of renal failure in patients with severe eclampsia. Clin Exp Obstet Gynecol 7: 219–222

    PubMed  CAS  Google Scholar 

  33. Goris RJA, Gimbrere JSF, Niekerk JLM, Schoots FJ, Booy HD (1982) Early ostheosynthesis and prophylactic mechanical ventilation in the multitrauma patient. J Trauma 22: 895–903

    Article  PubMed  CAS  Google Scholar 

  34. Graziani G, Cantaluppi A, Casati S, Citterio A, Scalamogna A, Aroldi A, Silenzio R, Brancaccio D, Ponticelli C (1984) Dopamine and frusemide in oligurie acute renal failure. Nephron 37: 39–42

    Article  PubMed  CAS  Google Scholar 

  35. Gurevitch MJ, Van Dyke J, Young ES, Kackson K (1986) Improved oxygenation and lower peak airway pressure in severe adult respiratory distress syndrome. Treatment with inverse ratio ventilation. Chest 89: 211–213

    Google Scholar 

  36. Hickling KG, Henderson SJ, Jackson R (1990) Low mortality associated with low volume pressure limited ventilation with permissive hypercapnia in severe adult respiratory distress syndrome. Intensive Care Med 16: 372–377

    Article  PubMed  CAS  Google Scholar 

  37. Hillman K (1990) Prevention of posttraumatic complications. In: Vincent JL (ed) Update of intensive care and emergency medicine, 10. Springer, Berlin Heidelberg New York Tokyo, pp 514–519

    Google Scholar 

  38. Holcroft JW, Vassar MJ, Turner JE, Deriet RW, Kramer GC (1987) 3% NaCI and 7,5% NaCI/Dextran 70 in the resuscitation of severely injured patients. Ann Surg 206: 279–288

    Google Scholar 

  39. Inque S, Epstein MD, Alexander JW, Trocki O, Jacobs P, Gura P (1989) Prevention of yeast translocation across the gut by a single enteral feeding after burn injury. J Parenter Enteral Nutr 13: 565–571

    Article  Google Scholar 

  40. Johnson KD, Cadambi A, Seibert GB (1985) Incidence of adult respiratory distress syndrome in patients with multiple muscoloskeletal injuries: Effect of early operative stabilisation of fractures. J Trauma 25: 375–384

    Google Scholar 

  41. Kerver AJH, Rommes JH, Mevissen-Verhage EAE, Hulstaert PF, Vos A, Verhoef J, Wittebol P (1988) Prevention of colonization and infection in critically ill patients: a prospective randomized study. Crit Care Med 16: 1087–1093

    Article  PubMed  CAS  Google Scholar 

  42. Klein S (1990) Glutamine: An essential nonessential aminoacid for the gut. Gastroenterology 99: 281–297

    Google Scholar 

  43. Knaus WA, Draper EA, Wagner DP, Zimmermann JE (1985): Prognosis in acute organ-system failure. Ann Surg 202: 685–693

    Article  PubMed  CAS  Google Scholar 

  44. Koller W, Benzer H, Duma S, Mutz N, Pauser G (1983) Ein Modell zur einheitlichen Behandlung and Therapieauswertung beim schweren ARDS. Anaesthesist 32: 576–581

    PubMed  CAS  Google Scholar 

  45. Kottler BM, Decker KD, Deutsch H, Fretschner R (1992) Lähmungen durch Kohlenhydrate–Die Rolle der Hypernatriämie. Anaesthesist 41: 302–303

    PubMed  CAS  Google Scholar 

  46. Lachmann B, Johnson B, Linroth M, Robertson B (1982) Models of artificial ventilation in severe respiratory distress syndrome. Lung function and morphology in rabbits after wash-out of alveolar surfactant. Crit Care Med 10: 724–732

    Google Scholar 

  47. Lazarus JM (1990) Prophylaxis of acute renal failure in the intensive care unit. In: Bihari D, Neild G (eds) Acute renal failure in the intensive therapy unit. Springer, Berlin Heidelberg New York Tokyo, pp 279–308

    Chapter  Google Scholar 

  48. Ledingham McAI, Alcock SR, Eastaway AT, McDonald JC, McKay IC, Ramsay G (1988) Triple regimen of selective decontamination of the digestive tract, systemic cefotaxime, and microbiological surveillance for prevention of acquired infection in intensive care. Lancet 1: 785–790

    Article  PubMed  CAS  Google Scholar 

  49. Lewandowski K, Slama K, Falke JK (1992) Approaches to improve survival in severe ARDS. In: Vincent JL (ed) Yearbook of intensive care and emergency medicine 1992. Springer, Berlin Heidelberg New York Tokyo, pp 372–383

    Google Scholar 

  50. Lindner A (1983) Synergism of dopamine and frusemide in diuretic-resistant, oliguric acute renal failure. Nephron 33: 121–126

    Article  PubMed  CAS  Google Scholar 

  51. Lo CW, Walker WA (1989) Changes in the gastrointestinal tract during enteral or parenteral feeding. Nutr Rev 47: 193–198

    Article  PubMed  CAS  Google Scholar 

  52. Mang H, Rügheimer E, Frostell CG (1992) Gefahren and Möglichkeiten der Therapie mit inhaliertem Stickstoffmonoxid. Intensivmedizin 29: 107–113

    Google Scholar 

  53. Marshall JC (1992) Multiple organ failure and infection: cause, consequence, or coincidence. In: Vincent JL (ed) Yearbook of intensive care and emergency medicine 1992. Springer, Berlin Heidelberg New York Tokyo, pp 3–13

    Google Scholar 

  54. Marshall JC, Sweeney D (1990) Microbial infection and the septic response in critical surgical illness. Sepsis, not infection, determines outcome. Arch Surg 125: 17–25

    Google Scholar 

  55. Maunder RJ, Shuman WP, McHugh JW, Marglin SI, Butler J (1986) Preservations of normal lung regions in the adult respiratory distress syndrome. Analysis by computed tomography. J Am Med Assoc 255: 2463–2465

    Google Scholar 

  56. McClelland P, Murray AE, Williams PS, van Saene HKF, Gilbertson AA, Mostafa SM, Bone JM (1990) Reducing sepsis in severe combined acute renal and respiratory failure by selective decontamination of the digestive tract. Crit Care Med 18: 935–939

    Article  PubMed  CAS  Google Scholar 

  57. Messmer K, Kreimeier U (1989) Microcirculatory therapy in shock. Resuscitation 18 [Suppl]: S 51–5 61

    Article  Google Scholar 

  58. Mochizuki H, Trocki O, Dominioni L, Brackett KA, Joffe SN, Alexander JW (1984) Mechanisms of prevention of postburn hypermetabolism and catabolism by early enteral feeding. Ann Surg 200: 297–310

    Article  PubMed  CAS  Google Scholar 

  59. Montgomery AB, Stager MA, Carrico CJ, Hudson LD (1985) Causes of mortality in patients with adult respiratory distress syndrome. Am Rev Respir Dis 132: 485–489

    PubMed  CAS  Google Scholar 

  60. Moore FA, Moore EE, Jones TN, McCroskey BL, Peterson VM (1989) TEN versus TPN following major abdominal trauma–Reduced septic morbidity. J Trauma 29: 916–923

    Article  PubMed  CAS  Google Scholar 

  61. Murray JF, Matthay MA, Luce JM, Flick MR (1988) An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis 138: 720–723

    PubMed  CAS  Google Scholar 

  62. Nast-Kolb D, Kessler S, Duswald KH, Betz A, Schweiberer L (1986) Extremitätenverletzungen polytraumatisierter Patienten: stufengerechte Behandlung. Unfallchirurgie 89: 149–154

    CAS  Google Scholar 

  63. Pesenti A (1990) Target blood gases during ARDS ventilatory management. Intens Care Med 16: 349–351

    Article  CAS  Google Scholar 

  64. Petty TL, Asbaugh DG (1971) The adult respiratory distress syndrome: Clinical features, factors influencing prognosis and principles of management. Chest 60: 233–239

    Google Scholar 

  65. Pingleton SK (1988) Complications of acute respiratory failure. Am Rev Respir Dis 137: 1463–1493

    PubMed  CAS  Google Scholar 

  66. Räsänen J, Cane RD, Downs JB, Hurst JM, Jousela IT, Kirby RR, Rogove HJ, Stock MC (1991) Airway pressure release ventilation during acute lung injury: A prospective multicenter trial. Crit Care Med 19: 1234–1241

    Google Scholar 

  67. Rossaint R, Slama K, Falke KJ (1991) Therapie des akuten Lungenversagens. Dtsch Med Wochenschr 116: 1635–1639

    Article  PubMed  CAS  Google Scholar 

  68. Shapiro BA, Cane RD, Harrison RA (1984) Positive end-expiratory pressure therapy in adults with special reference to acute lung injury: A review of the literature and suggested clinical correlations. Crit Care Med 12: 127–141

    Google Scholar 

  69. Shoemaker WC, Bland RD, Appel PL (1985) Therapy of critically ill postoperative patients based on outcome prediction and prospective clinical trials. Surg Clin North Am 65: 811–833

    PubMed  CAS  Google Scholar 

  70. Smith RJ (1990) Glutamine metabolism and its physiologic importance. J Parenter Enteral Nutr 14 [Suppl]: S40-S 43

    Google Scholar 

  71. Sori AJ, Rush BFjr, Lysz TW, Smith SM, Machiedo GW (1986) The gut as a source of sepsis after hemorrhagic shock. Am J Surg 155: 187–192

    Article  Google Scholar 

  72. Stock MC, Downs JB, Frohlicher DA (1987) Airway pressure release ventilation. Crit Care Med 15: 462–466

    Article  PubMed  CAS  Google Scholar 

  73. Stoutenbeek CP, Saene HKF van, Miranda DR, Zandstra DF (1984) The effect of selective decontamination of the digestive tract on colonisation and infection rate in multiple trauma patients. Intens Care Med 10: 185–192

    Article  CAS  Google Scholar 

  74. Stoutenbeek CP, Saene HKF van, Miranda DR, Zandstra DF, Binnendijk B (1984) The prevention of superinfection in multiple trauma patients. J Antimicrob Chemother 14 [Suppl. B]: 203–211

    Google Scholar 

  75. Sydow M, Burchardi H, Crozier TA, Rüchel R, Busse C, Seyde W (1990) Einfluß der selektiven Dekontamination auf nosokomiale Infektionen, Erregerspektrum und A ntibiotikaresistenz bei langzeitbeatmeten Intensivpatienten. Anästh Intensivther Notfallmed 25: 416–423

    Google Scholar 

  76. Tharratt RS, Allen RP, Albertson TE (1988) Pressure controlled inverse ratio ventilation in severe adult respiratory failure. Chest 94: 755–762

    Article  PubMed  CAS  Google Scholar 

  77. Tokioka H, Saito S, Kosaka F (1989) Effect of pressure support ventilation on breathing patterns and respiratory work. Intens Care Med 15: 491–494

    Article  CAS  Google Scholar 

  78. Tscherne H, Sturm JA, Regel G (1987) 2. Die prognostische Bedeutung der Frühversorgung am Beispiel des Unfallpatienten. Langenbecks Arch Chir 372: 37–42

    Google Scholar 

  79. Uffelen R van, Saene HKF van, Fidler V, Lowenburg A (1984) Oropharyngeal flora as a source of bacteria colonizing the lower airways in patients on artificial ventilation. Intens Care Med 10: 233–237

    Article  Google Scholar 

  80. Ulrich C, Harinck-de Veerd JE, Bakker NC, Jacz K, Doornbosh I, De Ridder VA (1989) Selective decontamination of the digestive tract with norfloxacin in the prevention of ICU-acquired infections: a prospective randomized study. Intens Care Med 15: 424–431

    Article  CAS  Google Scholar 

  81. Vassar MJ, Perry CA, Holcroft JW (1990) Analysis of potential risks associated with 7.5% sodium chloride resuscitation of traumatic shock. Arch Surg 125: 1309–1315

    Article  PubMed  CAS  Google Scholar 

  82. Velasco IT, Pontieri V, Rocha-e-Silva M, Lopes 0 (1980) Hyperosmotic NaC1 and severe hemorrhagic shock. Am J Physiol 239:H664-H 673

    Google Scholar 

  83. Waldhausen E, Keser G (1991) Lähmungen durch Kohlenhydrate unter der Intensivtherapie. Anaesthesist 40: 332–338

    PubMed  CAS  Google Scholar 

  84. Witt NJ, Zochodne DW, Bolton CF, Grand’Maison F, Wells G, Young GB, Sibbald WJ (1991) Peripheral nerve function in sepsis and multiple organ failure. Chest 99: 176–184

    Article  PubMed  CAS  Google Scholar 

  85. Zochodne DW, Bolton CF, Wells GA, Gilbert JJ, Hahn AF, Sibbald WA (1987) Critical illness polyneuropathy: a complication of sepsis and multiple organ failure. Brain 110: 819–841

    Article  PubMed  Google Scholar 

Download references

Authors
  1. H. Burchardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Sydow
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Medizinische Klinik I, Städtisches Krankenhaus Hildesheim Lehrkrankenhaus, Medizinischen Hochschule Hannover, Weinberg 1, W-3200, Hildesheim, Deutschland

    Hans-Peter Schuster

Rights and permissions

Reprints and permissions

Copyright information

© 1993 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Burchardi, H., Sydow, M. (1993). Prophylaxe und Therapie der akuten respiratorischen Insuffizienz und des ARDS. In: Schuster, HP. (eds) Intensivtherapie bei Sepsis und Multiorganversagen. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-07960-7_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-07960-7_11

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-07961-4

  • Online ISBN: 978-3-662-07960-7

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation