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Inzidenz, Ursachen und Prognose von Organversagen bei Patienten mit malignen Erkrankungen

Incidence, reasons and prognosis of organ failure in critically ill patients with underlying malignant disease

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Intensivmedizin und Notfallmedizin

Abstract

In recent years, survival of patients with hemato-oncological malignancies has substantially improved, particularly, because of new and intensive chemotherapeutic regimes including bone marrow and stem cell transplantation and better supportive care on the other hand. But the use of aggressive therapeutic regimes frequently results in complications, requiring transfer to the intensive care unit (ICU). Once a patient requires advanced intensive care support, the prognosis is particularly poor. Special risk factors analyzed are respiratory failure requiring mechanical ventilation, allogeneic bone marrow transplantation, or development of multiple organ failure. Further analyses of predictive indicators are necessary in order to predict the clinical course in our patients. In this review different prognostic indicators like age, the prognosis of the hemato-oncologic malignancy, the influence of stem cell transplantation, respiratory failure, renal or hepatic failure are demonstrated as well as the impact of different intensive care scoring systems.

Zusammenfassung

In den letzten Jahren hat sich die Prognose hämato-onkologischer Patienten teilweise deutlich verbessert. Ursächlich sind neue, teils interdisziplinäre Therapiestrategien einschließlich der Knochenmarksoder peripheren Stammzelltransplantation, teils aber auch verbesserte supportive Maßnahmen. Dennoch führen aggressive Therapieformen auch zu vermehrten Komplikationen, die eine intensivmedizinische Therapie notwendig machen. Mit der Notwendigkeit der intensivmedizinischen Versorgung verschlechtert sich die Prognose dieser Patienten entscheidend. Spezielle Risikofaktoren sind beatmungspflichtiges Lungenversagen, allogene Knochenmarkstransplantation oder Multiorganversagen. Vor diesem Hintergrund sind Analysen prädiktiver Faktoren notwendig, die den Verlauf bei den Patienten voraussagen. In dieser Arbeit werden Hinweise zur Einschätzung der Situation kritisch kranker Tumorpatienten gegeben. Neben der allgemeinen Beurteilung der Ausgangssituation wird über Einflussfaktoren wie das Alter der Patienten, die Prognose der Grunderkrankung, das Vorliegen einer Stammzelltransplantation sowie Organversagen wie z. B. die respiratorische Insuffizienz und das Nieren- oder Leberversagen berichtet und der Nutzen verschiedener Intensivscoringsysteme erläutert.

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  1. Klinik und Poliklinik für Innere Medizin I, Klinikum der Universität Regensburg, 93042, Regensburg, Germany

    T. Brünnler

  2. Abteilung für Hämatologie und internistische Onkologie, Universität Regensburg, Regensburg, Germany

    S. W. Krause

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Serie: Die Notfall- und Intensivtherapie bei hämatologischen und onkologischen Erkrankungen Herausgegeben von E. Holler und C. Wrede (Regensburg)

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Brünnler, T., Krause, S.W. Inzidenz, Ursachen und Prognose von Organversagen bei Patienten mit malignen Erkrankungen. Intensivmed 44, 20–30 (2007). https://doi.org/10.1007/s00390-007-0749-y

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