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Zerebrales und neurophysiologisches Monitoring

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Die Intensivmedizin

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Zusammenfassung

Ein erweitertes zerebrales, neurophysiologisches Monitoring dient bei zerebral geschädigten Patienten, z. B. nach einer aneurysmatischen Subarachnoidalblutung oder einem schweren Schädel-Hirn-Trauma dazu, noch gesundes Hirngewebe in seiner Funktion zu überwachen und vor sekundären Schädigungen zu bewahren.

Dieses dient im Wesentlichen eine physikalische oder funktionelle zerebrale Hypoxie (auf Grund von zerebraler Hypotonie, erhöhtem intrakraniellem Druck, verminderter Sauerstoffversorgung, vermindertem zerebralem Blutfluss oder anaerobem Zellstoffwechsel) zu detektieren und entsprechende Gegenmaßnahmen zu ergreifen.

Neben dem Basismonitoring intubierter, schwer zerebral geschädigter Patienten in Form einer Messung des intrakraniellen Drucks (ICP) und dadurch Bestimmung des zerebralen Perfusionsdrucks (CPP) wurden in den vergangenen zwei Jahrzehnten verschiedene, invasive Monitoringverfahren entwickelt, mit denen sich z. B. der Hirngewebe Sauerstoff-Partialdruck (ptiO2), der zerebrale Blutfluss (CBF) und der Hirnstoffwechsel (Mikrodialyse) bestimmen lässt.

Von diesen kommerziell erhältlichen Verfahren hat jedoch lediglich die ptiO2-Messung einen weiteren Einzug in die klinische Routine und in international Empfehlungen vollzogen.

Weitere noninvasive Verfahren zur Messung der zerebralen Sauerstoffversorgung durch Infrarot Spektroskopie (NIRS) oder der vegetativen Funktion (Pupillometrie) wurden entwickelt und werden in einzelnen Zentren angewandt.

Prospektive, randomisierte und kontrollierte Studien, wonach ein erweitertes zerebrales Monitoring des Outcome von Patienten verbessert, fehlen jedoch aktuell noch,

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Authors and Affiliations

  1. Neurochirurgische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    Martin Jakobs, Alexander Younsi & Karl Ludwig Kiening

  2. Clinique des Grangettes, Chene-Bougeries, Schweiz

    Asita Simone Sarrafzadeh

Authors
  1. Martin Jakobs
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  2. Alexander Younsi
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  3. Asita Simone Sarrafzadeh
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  4. Karl Ludwig Kiening
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Corresponding author

Correspondence to Martin Jakobs .

Editor information

Editors and Affiliations

  1. Klinik für Anästhesiologie, RWTH Aachen Universitätsklinikum Aachen, Aachen, Deutschland

    Gernot Marx

  2. Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lübeck, Deutschland

    Elke Muhl

  3. Dir. der Klinik fuer Anaesthesie Intensivmed. und Schmerzther., Frankfurt, Hessen, Deutschland

    Kai Zacharowski

  4. Medizinische Klinik 1, Universitätsklinikum Frankfurt, Frankfurt am Main, Hessen, Deutschland

    Stefan Zeuzem

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Jakobs, M., Younsi, A., Sarrafzadeh, A.S., Kiening, K.L. (2022). Zerebrales und neurophysiologisches Monitoring. In: Marx, G., Muhl, E., Zacharowski, K., Zeuzem, S. (eds) Die Intensivmedizin. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54675-4_22-2

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  • DOI: https://doi.org/10.1007/978-3-642-54675-4_22-2

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  • Print ISBN: 978-3-642-54675-4

  • Online ISBN: 978-3-642-54675-4

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Chapter history

  1. Latest

    Zerebrales und neurophysiologisches Monitoring
    Published:
    25 November 2022

    DOI: https://doi.org/10.1007/978-3-642-54675-4_22-2

  2. Original

    Zerebrales und neurophysiologisches Monitoring
    Published:
    25 March 2015

    DOI: https://doi.org/10.1007/978-3-642-54675-4_22-1

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