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Intensivmedizin up2date 2012; 08(03): 193-209
DOI: 10.1055/s-0032-1310166
DOI: 10.1055/s-0032-1310166
Pädiatrische Intensivmedizin
Therapeutische Hypothermie bei Neugeborenen und Kindern
Further Information
Publication History
Publication Date:
13 August 2012 (online)
Es gibt wenige neue Therapieverfahren, die einen so eindeutig positiven Effekt auf die Langzeitprognose haben, wie die therapeutische Hypothermie nach schwerer perinataler Asphyxie des Neugeborenen. Sowohl die Überlebensrate als auch das neurologische Outcome verbessert sich signifikant.
Es ist möglich, dass die therapeutische Hypothermie auch nach Kreislaufstillstand im Kindesalter zu besseren Behandlungsergebnissen beitragen kann. Die diesbezüglichen Daten und Empfehlungen sind uneinheitlich und machen Einzelfallentscheidungen im Rahmen eines individuellen Heilversuchs notwendig. Weitere mögliche Indikationen werden untersucht und haben heute noch experimentellen Charakter.
Trotz des gut belegten Nutzens der Hypothermiebehandlung für einige Indikationen sind grundlegende Mechanismen, Wirkungsweise und optimaler Modus der Durchführung nicht vollständig geklärt. In den kommenden Jahren ist eine weitere Optimierung der klinischen Anwendung zu erwarten.
Die Durchführung der Hypothermie ist mit temperaturabhängigen physiologischen Veränderungen und Risiken verbunden, die vorausschauend überwacht und ggf. gezielt therapiert werden müssen.
Bei gegebener Indikation sollte ein früher Behandlungsbeginn angestrebt werden. Zur Kühlung eignen sich bei Neugeborenen und Kleinkindern neben Coolpacks und kalten Tüchern temperaturgesteuerte Kühlmatten. Die Wiederaufwärmung erfolgt sehr langsam und kontrolliert.
Die neurologische Beurteilbarkeit ist unter Hypothermie eingeschränkt. Die neurologische Gesamtprognose ergibt sich im Einzelfall aus der Anamnese und dem Verlauf aller klinischen, apparativen und Laborbefunde.
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