Intensivtherapie des raumfordernden ischämischen Hemisphäreninfarkts

Zusammenfassung der NCS/DGNI-Leitlinie

Intensive care therapy of space-occupying large hemispheric infarction

Summary of the NCS/DGNI guidelines

Zusammenfassung

Der große ischämische Hemisphäreninfarkt („large hemispheric infarction“, LHI, Synonym maligner Mediainfarkt, MMI) ist eine schwerwiegende neurologische Erkrankung mit hoher Mortalität und Morbidität. Sowohl behandelnde Ärzte als auch Angehörige sehen sich insbesondere hinsichtlich konservativer Therapiemaßnahmen mit einer schwachen Datenlange konfrontiert. Aktuelle Leitlinien zur allgemeinen Schlaganfallbehandlung legen den Hauptfokus auf Risikofaktoren, Prävention und das akute Rekanalisierungsmanagement, beinhalten aber nur sehr limitierte Empfehlungen zur ggf. folgenden spezifischen intensivmedizinischen Behandlung. Um diese Lücke zu füllen, wurde kürzlich eine interdisziplinäre Konsensus-Konferenz der Neurocritical Care Society (NCS) und der Deutschen Gesellschaft für NeuroIntensiv- und Notfallmedizin (DGNI) zum intensivmedizinischen Management des MMI organisiert. Experten aus Neurologie, Neurointensivmedizin, Neurochirurgie, Neuroradiologie und Neuroanästhesie aus Europa und Nordamerika wurden auf Basis ihrer Expertise und ihrer Forschungsschwerpunkte ausgewählt. Arbeitsgruppen zu einzelnen Schwerpunktthemen erarbeiteten eine Reihe zentraler klinischer Fragestellungen zu diesem Thema und erstellten auf dem Boden der aktuellen Datenlage nach dem System Grading of Recommendation Assessment, Development and Evaluation (GRADE) Empfehlungen. Dies ist eine kommentierte Kurzfassung derselben.

Summary

Large hemispheric infarction (LHI), synonymously called malignant middle cerebral artery (MCA) infarction, is a severe neurological disease with a high mortality and morbidity. Treating physicians as well as relatives are often faced with few and low quality data when attempting to apply optimal treatment to these patients and make decisions. While current stroke treatment guidelines focus on risk factors, prevention and acute management, they include only limited recommendations concerning intensive care management of LHI. The Neurocritical Care Society (NCS) and the German Society for Neurocritical and Emergency Medicine (DGNI) organized an interdisciplinary consensus conference on intensive care management of LHI to meet this demand. European and American experts in neurology, neurocritical care, neurosurgery, neuroradiology and neuroanesthesiology were selected based on their expertise and research focus. Subgroups for several main topics elaborated a number of central clinical questions concerning this topic and evaluated the quality of the currently available data according to the grading of recommendation assessment, development and evaluation (GRADE) guideline system. Subsequently, evidence-based recommendations were compiled after weighing the advantages against the disadvantages of certain management options. This is a commented abridged version of the results of the consensus conference.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. J. Bösel, S. Schönenberger, C. Dohmen, E. Jüttler, D. Staykov, K. Zweckberger, W. Hacke, S. Schwab, M.T. Torbey und H.B. Huttner geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Correspondence to PD Dr. J. Bösel.

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J. Bösel und S. Schönenberger haben gleichermaßen zu der Publikation beigetragen.Dieser Beitrag ist eine übersetzte und kommentierte Kurzfassung von Torbey MT, Bösel J, Rhoney DH et al (2015) Evidence-based guidelines for the management of large hemispheric infarction: a Statement for Health Care Professionals from the Neurocritical Care Society and the German Society for Neuro-Intensive Care and Emergency Medicine. Neurocrit Care 22:146–164.

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Bösel, J., Schönenberger, S., Dohmen, C. et al. Intensivtherapie des raumfordernden ischämischen Hemisphäreninfarkts. Nervenarzt 86, 1018–1030 (2015). https://doi.org/10.1007/s00115-015-4361-2

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Schlüsselwörter

  • Hemikraniektomie
  • Zerebrales Ödem
  • Schlaganfall
  • Mediainfarkt
  • Empfehlungen

Keywords

  • Cerebral edema
  • Hemicraniectomy
  • Stroke
  • Middle cerebral artery Infarction
  • Recommendations