Postoperative respiratorische Insuffizienz und ihre Behandlung

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• 作者：V. K?sek ; PD Dr. K. Wiebe
• 关键词：Postoperative pulmonale Komplikationen ; Akutes Lungenversagen ; Protektive Beatmung ; Extrakorporale Membranoxygenierung (ECMO) ; Lungenunterstützung ; Acute lung injury ; Acute respiratory distress syndrome ; Protective ventilation ; Extracorporeal membrane oxygenation ; Lung assist
• 刊名：Der Chirurg
• 出版年：2015
• 出版时间：May 2015
• 年：2015
• 卷：86
• 期：5
• 页码：437-443
• 全文大小：485 KB
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• 作者单位：V. K?sek (1)
  PD Dr. K. Wiebe (1)
  
  1. Sektion für Thoraxchirurgie, Department für Herz- und Thoraxchirurgie, Universit?tsklinikum Münster, Albert-Schweitzer-Campus 1A, 48149, Münster, Deutschland
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Surgery
  Cardiac Surgery
  Pediatric Surgery
  Plastic Surgery
  Traumatic Surgery
  Vascular Surgery
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1433-0385

文摘

The development of a postoperative respiratory insufficiency is typically caused by several factors and include patient-related risks, the extent of the procedure and postoperative complications. Morbidity and mortality rates in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are high. It is important to have consistent strategies for prevention and preoperative conditioning is essential primarily for high-risk patients. Treatment of established postoperative lung failure requires early tracheotomy, protective ventilation (tidal volume 6?ml/kg body weight), elevated positive end expiratory pressure (PEEP, 10-0?mmH₂O), recurrent bronchoscopy and early patient mobilization. In critical cases an extracorporeal lung assist is considered to be beneficial as a bridge to recovery and for realizing a protective ventilation protocol. Different systems with separate indications are available. The temporary application of a lung assist allows thoracic surgery to be performed safely in patients presenting with insufficient respiratory function.