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Erschienen in:

06.08.2018 | Pflege | Journal Club

Intensivmedizinische Studien aus 2017/2018

verfasst von: C. J. Reuß, M. Bernhard, C. Beynon, A. Hecker, C. Jungk, C. Nusshag, Prof. Dr. med. M. A. Weigand, D. Michalski, T. Brenner

Erschienen in: Die Anaesthesiologie | Ausgabe 9/2018

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Einen Überblick über die gesamten Veröffentlichungen in der Intensivmedizin zu behalten, ist heutzutage aufgrund der großen Fülle an ständig neu publizierten Arbeiten für den Einzelnen kaum mehr möglich. Es wurde daher die Expertise der relevanten intensivmedizinischen Fachbereiche in einem interdisziplinären Team gebündelt, um dem klinisch tätigen Intensivmediziner einen fächerübergreifenden Überblick über neue Erkenntnisse des vergangenen Jahres geben zu können. Dabei kann eine derartige Zusammenstellung immer nur subjektiv geschehen. Dennoch haben wir versucht, die relevantesten Themengebiete und Fragestellungen übersichtlich zusammenzufassen. Hierfür haben wir uns an einem im vergangen Jahr erschienenen Übersichtsartikel [1] der Editoren des Journals Intensive Care Medicine orientiert, welcher die 10 relevantesten Schwerpunkte der perioperativen, intensivmedizinischen Forschung der kommenden Jahre definiert hat (Tab. 1). Das Krankheitsbild, das zwar nicht explizit erwähnt, aber von den meisten dieser Begriffe eingeschlossen wird und bereits seit Jahrzehnten die intensivmedizinische Forschung dominiert, ist die Sepsis. So wird der Leser auch in dieser Zusammenfassung eine Vielzahl an Studien zur Behandlung der Sepsis finden (Tab. 2). Neben neuen Erkenntnissen aus der Leitlinie zur Behandlung der Sepsis und des septischen Schocks [2] beleuchten wir explizit die Flüssigkeits-, antiinfektive, aber auch adjunktive Therapie. Zudem werden Studien zu Beatmung, dem Organversagen, der Transfusionsstrategie und der Ernährung von Intensivpatienten vorgestellt. Des Weiteren werden aus der Perspektive der neurologischen und neurochirurgischen Intensivmedizin relevante, neue Erkenntnisse zusammengefasst.

Tab. 1

Aktuelle Forschungsschwerpunkte der perioperativen Intensivmedizin. (Nach Gillies et al. [1])

Flüssigkeitstherapie	Respiratorische Komplikationen
Postoperative Aufnahme auf Intensivstation	Blutungsmanagement
Zielorientierte Therapie („goal-directed therapy“)	Beatmungseinstellungen
Delirium	Immundysfunktion
Akute Nierenschädigung	Antiinfektive Therapie

Tab. 2

In den Jahren 2017/2018 erschienene intensivmedizinische Studien und die Bedeutung der Akronyme

Akronym	Bedeutung des Akronyms	Originaltitel der Studie	Ergebnis – kurz zusammengefasst
PRISM	Protocolized Resuscitation in Sepsis Meta-Analysis	Early, Goal-Directed Therapy for Septic Shock—A Patient-Level Meta-Analysis	Protokollbasierte Therapie verringerte die Sterblichkeit bei Patienten mit septischem Schock nicht
MEDUSA	Medical Education for Sepsis Source Control and Antibiotics	Effect of a multifaceted educational intervention for anti-infectious measures on sepsis mortality: a cluster randomized trial	Ein Edukationsprogramm konnte die Zeit bis zur ersten Antibiotikaapplikation oder das Überleben bei Patienten mit Sepsis nicht verbessern
ADRENAL	Adjunctive Corticosteroid Treatment in Critically Ill Patients with Septic Shock	Adjunctive Glucocorticoid Therapy in Patients with Septic Shock	Hydrokortison konnte bei beatmeten Patienten im septischen Schock die Sterblichkeit nicht verringern
APROCCHSS	Activated Protein C and Corticosteroids for Human Septic Shock	Hydrocortisone plus Fludrocortisone for Adults with Septic Shock	Hydrokortison in Kombination mit Fludrocortison konnte bei Patienten im septischen Schock die Sterblichkeit verringern
ATHOS-3	Angiotensin II for the Treatment of High-Output Shock	Angiotensin II for the Treatment of Vasodilatory Shock	Angiotensin II konnte den Blutdruck bei Patienten im vasodilatativen Schock effektiv erhöhen
CIGMA	Concentrated IgM for Application	Efficacy and safety of trimodulin, a novel polyclonal antibody preparation, in patients with severe community-acquired pneumonia: a randomized, placebo-controlled, double-blind, multicenter, phase II trial	Trimodulin konnte die beatmungsfreien Tage bei beatmeten Patienten mit ambulant erworbener Pneumonie nicht verringern
ART	Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial	Effect of Lung Recruitment and Titrated Positive End-Expiratory Pressure (PEEP) vs Low PEEP on Mortality in Patients With Acute Respiratory Distress Syndrome	Höherer PEEP und Recruitment-Manöver führten bei Patienten mit ARDS zu erhöhter Sterblichkeit
PRESERVE	Prevention of Serious Adverse Events Following Angiography	Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine	Weder Natriumbikarbonat noch Acetylcystein konnten die Sterblichkeit oder das kontrastmittelinduzierte Nierenversagen nach Angiographie positiv beeinflussen
SMART	Isotonic Solutions and Major Adverse Renal Events Trial	Balanced Crystalloids versus Saline in Critically Ill Adults	Balancierte Kristalloide konnten im Vergleich zu NaCl bei kritisch kranken Patienten die Sterblichkeit sowie die Rate an Nierenersatzverfahren und renaler Dysfunktion vermindern
TRICS III	Transfusion Requirements in Cardiac Surgery III	Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery	Eine restriktive Transfusionsstrategie erhöhte bei kardiochirurgischen Patienten mit mittlerem bis hohem Risikoprofil die Sterblichkeit oder die Häufigkeit von Myokardinfarkt, Apoplex und dialysepflichtigem Nierenversagen nicht
TRICOP	Transfusion Requirements in Critically Ill Oncologic Patients	Liberal Versus Restrictive Transfusion Strategy in Critically Ill Oncologic Patients: The Transfusion Requirements in Critically Ill Oncologic Patients Randomized Controlled Trial	Eine liberale Transfusionsstrategie zeigte bei onkologischen Patienten mit septischem Schock einen Trend zu besserem Überleben
TRANSFUSE	Standard Issue Transfusion versus Fresher Red-Cell Use in Intensive Care	Age of Red Cells for Transfusion and Outcomes in Critically Ill Adults	Das Alter transfundierter Erythrozytenkonzentrate hatte bei kritisch kranken Patienten keinen Einfluss auf die Sterblichkeit
ISOS	International Surgical Outcomes Study	Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries	Die routinemäßige, postoperative Aufnahme auf Intensivstation brachte keinen Überlebensvorteil mit sich
EAT-ICU	Early goal-directed nutrition in ICU patients	Early goal-directed nutrition versus standard of care in adult intensive care patients: the single-centre, randomised, outcome assessor-blinded EAT-ICU trial	Eine protokollbasierte Ernährungsstrategie konnte bei beatmeten, kritisch kranken Patienten die Lebensqualität nach 6 Monaten nicht verbessern
NUTRIREA-2	Impact of Early Enteral vs. Parenteral Nutrition on Mortality in Patients Requiring Mechanical Ventilation and Catecholamines	Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study	Die frühe enterale, isokalorische Ernährung konnte bei beatmeten Patienten mit Schock das Überleben nicht verbessern
OBSERvE	Observation of critically ill patients in the resuscitation room of the Emergency Department	Resuscitation room management of critically ill nontraumatic patients in a German emergency department	Nichttraumatologische Schockraumpatienten stellen hohe Herausforderungen dar, die zahlreiche notfall- und intensivmedizinischen Interventionen notwendig machen
HIMALAI	Hypertension Induction in the Management of Aneurysmal Subarachnoid Haemorrhage with Secondary Ischaemia	Induced Hypertension for Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage	Induzierte Hypertension konnte bei Patienten mit aneurysmatischer Subarachnoidalblutung das neurologische Behandlungsergebnis nach 3 Monaten nicht verbessern
DEFUSE 3	Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke	Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging	Die mechanische Thrombektomie 6–16 h nach ischämischem Schlaganfall konnte, im Vergleich zur alleinigen, medikamentösen Therapie, das funktionelle, neurologische Behandlungsergebnis verbessern
DAWN	DWI or CTP Assessment with Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention with Trevo	Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct	Die mechanische Thrombektomie 6–24 h nach ischämischem Schlaganfall konnte, im Vergleich zur alleinigen, medikamentösen Therapie, das funktionelle, neurologische Behandlungsergebnis nach 90 Tagen verbessern
AnStroke	Anesthesia During Stroke	General Anesthesia Versus Conscious Sedation for Endovascular Treatment of Acute Ischemic Stroke	Weder Allgemeinanästhesie noch Analgosedierung zur Durchführung der mechanischen Thrombektomie konnten das neurologische Behandlungsergebnis nach 3 Monaten beeinflussen
GOLIATH	General or Local Anesthesia in Intra Arterial Therapy	Effect of general anesthesia and conscious sedation during endovascular therapy on infarct growth and clinical outcomes in acute ischemic stroke: a randomized clinical trial	Die Allgemeinanästhesie ist ein sicheres Vorgehen zur Durchführung der mechanischen Thrombektomie

PEEP „Positive End-Expiratory Pressure“, ARDS „Acute Respiratory Distress Syndrome“, DWI „Diffusion-Weighted Imaging“, CTP „Computerized Tomography Perfusion“

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Titel: Intensivmedizinische Studien aus 2017/2018
verfasst von: C. J. Reuß
M. Bernhard
C. Beynon
A. Hecker
C. Jungk
C. Nusshag
Prof. Dr. med. M. A. Weigand
D. Michalski
T. Brenner
Publikationsdatum: 06.08.2018
Verlag: Springer Medizin
Schlagwörter: Pflege
Sepsis
Sepsis
Septischer Schock
Erschienen in: Die Anaesthesiologie / Ausgabe 9/2018
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI: https://doi.org/10.1007/s00101-018-0474-x

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