Patienten mit interstitiellen Lungenerkrankungen auf der Intensivstation
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- 作者：Dr. J. Wälscher ; Prof. Dr. C. P. Heußel ; Prof. Dr. M. Kreuter
- 关键词：SchlüsselwörterAkute Exazerbation ; Mechanische Beatmung ; Nichtinvasive Beatmung ; Ateminsuffizienz ; Extrakorporale Membranoxygenierung
- 刊名：Der Pneumologe
- 出版年：2016
- 出版时间：September 2016
- 年：2016
- 卷：13
- 期：5
- 页码：294-307
- 全文大小：637 KB
- 刊物主题：Pneumology/Respiratory System; Medicine/Public Health, general; Allergology; Internal Medicine; Infectious Diseases; Oncology;
- 出版者：Springer Berlin Heidelberg
- ISSN：1613-6055
- 卷排序：13
文摘
Despite relevant advances in the treatment of interstitial lung diseases (ILD), morbidity and mortality in patients with ILD are high. Patients receiving intensive care treatment for acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) exhibit increased mortality. Determination of the possible causes of the respiratory failure is crucial for further treatment and reasons include acute exacerbations, right heart failure in pulmonary hypertension, infection, pulmonary embolism, drug-associated complications, and aggravation of comorbidities. In patients with suspected AE-IPF, a HRCT (high-resolution computed tomography; obligate without contrast agent) should be performed immediately in addition to a medical history and physical examination, which should in particular take into account the differential diagnoses. The current therapeutic regimen for AE-IPF consists of high-dose corticosteroids with tapering, and possibly antibiotics and immunosuppressants. The mortality rate for patients who require mechanical ventilation in acute exacerbation is 87 %. Therefore, mechanical ventilation is discouraged in the German IPF guideline if the underlying cause of respiratory failure is due to IPF progression. Only in potentially reversible disease should invasive ventilation be considered. The use of noninvasive ventilation may be discussed. The use of extracorporeal membrane oxygenation (ECMO) as a bridging therapy can be a lifesaving option for patients with ILD and acute respiratory failure, if they are candidates for lung transplantation. The poor prognosis, however, can not be altered by this action if they are not suitable for a lung transplant.