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Beatmung als Trigger für Organdysfunktion und Sepsis

Ventilation as a trigger for organ dysfunction and sepsis

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Zusammenfassung

Die mechanische Beatmung spielt in der intensivmedizinschen Therapie des kritisch kranken Patienten mit Lungenschädigung, aber auch in der vorübergehenden Beatmung lungengesunder Patienten eine zentrale Rolle. Die Beatmung ist per se nichtkurativ und wird unter Umständen von diversen schweren Nebenwirkungen begleitet. Dies nährt u. a. die Hypothese, dass ein Multiorganversagen durch Beatmung induziert werden kann und unterstützt die These eines „organ crosstalk“ zwischen Lunge und übrigen Organen. Dabei ist die Aktivierung von spezifischen Zellen und Zellprogrammen in peripheren Organen ein wichtiger Schritt auf dem Weg zum Multiorganversagen. Neben einer bidirektionalen Verbindung zwischen Lunge und Gehirn führt eine lungenschädigende Beatmung zu Zellapoptose in Nieren und Darm und zu einem Anstieg von Biomarkern für Organdysfunktion. Es wird vermutet, dass sowohl Entzündungsmediatoren als auch proapoptotische Faktoren dafür verantwortlich sind.

Abstract

Both in the intensive care setting and during surgery, mechanical ventilation plays an important role in the treatment of critically ill patients with lung injury, but also in lung healthy patients. Mechanical ventilation is noncurative and is accompanied by various severe side effects. It is hypothesized that multiorgan failure can be induced by mechanical ventilation. Furthermore, there is evidence to suggest cross-talk between lungs and other organs. In particular, the activation of specific cells and cell programs in peripheral organs is an important step on the way to multiorgan failure. In addition to bidirectional connection between the lung and brain, nonprotective ventilation leads to cell apoptosis in the kidney and intestine and leads to an increase of biomarkers for organ dysfunction. It is believed that both inflammation mediators and pro-apoptotic factors are responsible for organ dysfunction.

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  1. Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    J. Karsten

  2. Klinik für Anästhesiologie und Intensivmedizin, Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    H. Heinze MHBA

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Karsten, J., Heinze, H. Beatmung als Trigger für Organdysfunktion und Sepsis. Med Klin Intensivmed Notfmed 111, 98–106 (2016). https://doi.org/10.1007/s00063-015-0030-2

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