Der hämatoonkologische Patient im Intensivmanagement

Leitthema

Zusammenfassung

Eine oft nicht oder nur fraglich „heilbare“ Grunderkrankung, häufige therapieassoziierte Komplikationen und eventuell vorliegenden Immunsuppression machen kritisch kranke Patienten mit hämatologischer oder onkologischer Grunderkrankung zu einem besonderen Krankengut in der Intensivmedizin. Die Prognose dieser Patienten hat sich in den letzten Jahren als Folge zunehmenden Wissens um ihre Besonderheiten und optimierter supportiver Therapie deutlich verbessert. Eine generelle Zurückhaltung, akut kranke Krebspatienten auf eine Intensivstation aufzunehmen, ist dementsprechend keinesfalls gerechtfertigt. Häufig liegen infektiöse Komplikationen und/oder eine respiratorische Insuffizienz vor. Umfangreiche infektiologische Diagnostik, kausale und supportive Therapie entsprechend der geltenden Leitlinien kann die Prognose einer Sepsis auch bei hämatoonkologischen Patienten verbessern. In der Therapie des respiratorischen Versagens kommt der nichtinvasiven Beatmung ein hoher Stellenwert in der Reduktion der Mortalität zu, wenn sie früh und unter strenger Beachtung von Indikationen, Kontraindikationen und Abbruchskriterien eingesetzt wird. Die Prognose von kritisch kranken Krebspatienten wird durch die Schwere des akuten Problems bestimmt, nicht durch die Grunderkrankung.

Schlüsselwörter

Krebs Intensivstation Prognose Sepsis Nichtinvasive Beatmung 

Hematooncology patients in intensive care management

Abstract

Critically ill cancer patients on intensive units with hematological or oncological underlying diseases are a special situation: the underlying disease may be incurable, acute problems are often therapy associated and immunosuppression is regularly present. Due to evolving knowledge about special aspects of these patients and optimized supportive therapy, the prognosis has substantially improved during the last decades. General reluctance to admit cancer patients to an intensive care unit is therefore no longer justified. Reasons for admission are often infections and/or respiratory failure. Extensive diagnostic measures, causal and supportive therapy of sepsis according to current guidelines has led to improved outcome even in cancer patients. In respiratory failure, non-invasive ventilation is the key to improved prognosis if used early enough and indications, contraindications and break-off criteria are strictly followed. The prognosis of critically ill cancer patients is determined by the severity of the acute problem and not by the underlying disease.

Keywords

Cancer Intensive care unit Prognosis Sepsis Non-invasive ventilation 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Universitätsklinik für Innere Medizin I, Intensivstation 13.i2Medizinische Universität Wien, Allgemeines Krankenhaus der Stadt WienWienÖsterreich

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