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Ventilatorinduzierte diaphragmale Dysfunktion in der Kardiochirurgie

Pathomechanismen, Besonderheiten und Therapieansätze

Ventilatior-induced diaphragm dysfunction in cardiac surgery

Pathomechanisms, characteristics and therapy approaches

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Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Mechanische Beatmung ist lebensrettend für Patienten mit respiratorischer Insuffizienz oder der Notwendigkeit für eine tiefe Sedierung. Die resultierende Inaktivierung des Diaphragmas geht mit einer profunden Veränderung der muskulären Homöostase einher, die zu einer Muskelatrophie und Kraftreduktion des Diaphragmas führt. Der wichtigste Pathomechanismus ist die Generierung von oxidativem Stress, der letztendlich in einer Aktivierung der Apoptose resultiert. Die Geschwindigkeit unterscheidet sich deutlich von der peripherer Muskeln, sodass im Diaphragma bereits nach 18-stündiger Beatmung eine Atrophie um 30 % und ein 50 %iger Verlust der Kontraktionskraft nachweisbar ist. Dieser Beitrag gibt einen Überblick über die Pathomechanismen, die Besonderheiten des kardiochirurgischen Patientenguts und mögliche Therapieansätze geben.

Abstract

Mechanical ventilation is life-saving for patients with respiratory failure or the necessity for deep sedation. The resulting inactivation of the diaphragm has been revealed to induce myofiber atrophy of around 30 % after 18 h of mechanical ventilation and a contractile deficit of up to 50 %. These profound changes are rooted in a disturbed cellular homeostasis which arises from an increase in oxidative stress and results in cellular apoptosis. This article gives an overview of the major pathomechanisms, the influence of comorbidities in cardiac surgery patients and possible treatment options.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. C.S. Bruells, A. Goetzenich und R. Rossaint geben an, dass kein Interessenkonflikt besteht.

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Authors and Affiliations

  1. Klinik für Anästhesiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland

    C.S. Bruells & R. Rossaint

  2. Klinik für Thorax-, Herz-, und Gefäßchirurgie, Universitätsklinikum Aachen, Aachen, Deutschland

    A. Goetzenich

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  1. C.S. Bruells
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  2. A. Goetzenich
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  3. R. Rossaint
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Correspondence to C.S. Bruells.

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Bruells, C., Goetzenich, A. & Rossaint, R. Ventilatorinduzierte diaphragmale Dysfunktion in der Kardiochirurgie. Z Herz- Thorax- Gefäßchir 27, 419–423 (2013). https://doi.org/10.1007/s00398-013-1028-9

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  • DOI: https://doi.org/10.1007/s00398-013-1028-9

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