Zusammenfassung
Die pädiatrische Neurointensivmedizin erfordert multiprofessionelle Expertise für die Versorgung kritisch kranker Kinder. Zwischen 14 und 16 % aller kritisch kranken Kinder in der pädiatrischen Intensivmedizin leiden an einer primären neurologischen Erkrankung, wobei Kreislaufstillstände und schwere Schädel-Hirn-Traumata in Europa die größte Rolle spielen. Das kurzfristige Ziel intensivmedizinischer Therapie bei Kindern ist die Stabilisierung vitaler Funktionen, das übergeordnete Ziel hingegen ist ein Überleben ohne neurologische Schädigung, das die Ausschöpfung des individuellen entwicklungsphysiologischen Potenzials ermöglicht. Aus diesem Grund sind evidenzbasierte Methoden zur Überwachung des Gehirns während der akuten Krankheit und im Verlauf notwendig, die klinisch und apparativ durchgeführt werden. Dies gilt sowohl für Patienten mit primärer neurologischer Erkrankung als auch für alle Kinder mit einem Risiko für eine sekundäre neurologische Schädigung. Auch Patienten mit Erkrankungen des peripheren Nervensystems werden in der pädiatrischen Intensivmedizin behandelt. Hier gilt es häufig, die Zeit bis zur Rekonvaleszenz einer akuten Verschlechterung, beispielsweise im Rahmen einer Infektion, zu überbrücken. Eine besondere Herausforderung kann die Überwachung der zerebralen Funktion bei diesen Patienten darstellen, da durch die Grunderkrankung Untersuchungsergebnisse nicht wie bei vormals neurologisch gesunden Kindern interpretiert werden können. Diese Komplexität der der pädiatrischen Neurointensivmedizin, die im klinischen Alltag nur im multidisziplinären Team zu bewältigen ist, wird anhand der diagnostischen Möglichkeiten, verschiedener Krankheitsbilder und deren therapeutischen Optionen dargestellt.
Abstract
Pediatric neurocritical care requires multidisciplinary expertise for the care of critically ill children. Approximately 14–16% of critically ill children in pediatric intensive care suffer from a primary neurological disease, whereby cardiac arrest and severe traumatic brain injury play major roles in Europe. The short-term goal of interventions in the pediatric intensive care unit is to stabilize vital functions, whereas the overarching goal is to achieve survival without neurological damage that enables fulfillment of the individual developmental physiological potential. For this reason, evidence-based methods for brain monitoring during the acute phase and recovery are necessary, which can be performed clinically or with technical devices. This applies to critically ill children with primary neurological diseases and for all children at risk for secondary neurological insults. Patients with diseases of the peripheral nervous system are also treated in pediatric intensive care medicine. In these patients, the primary aim frequently consists of bridging the time until recovery after acute deterioration, for example during an infection. In these patients, monitoring the cerebral function can be especially challenging, because due to the underlying disease the results of the examination cannot be interpreted in the same way as for previously neurologically healthy children. This article summarizes the complexity of pediatric neurocritical care by presenting examples of diagnostic and therapeutic approaches in the context of various neurological diseases that can be routinely encountered in the pediatric intensive care unit and can only be successfully treated by multidisciplinary teams.
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N. Bruns, U. Schara-Schmidt und C. Dohna-Schwake geben an, dass kein Interessenkonflikt besteht.
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Bruns, N., Schara-Schmidt, U. & Dohna-Schwake, C. Pädiatrische Neurointensivmedizin. Nervenarzt 94, 75–83 (2023). https://doi.org/10.1007/s00115-022-01424-w
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DOI: https://doi.org/10.1007/s00115-022-01424-w