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Erschienen in: Wiener klinisches Magazin 1/2019

17.01.2019 | Intensivmedizin

Intestinaler Crosstalk

Der Darm als Motor des Multiorganversagens

verfasst von: Univ.-Prof. Dr. Wilfred Druml

Erschienen in: Wiener klinisches Magazin | Ausgabe 1/2019

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Zusammenfassung

Die zentrale Rolle des Organsystems Darm für den Intensivpatienten ist erst im letzten Jahrzehnt voll erkannt worden. Der Darm ist ein entscheidendes immunologisches, metabolisches und neurologisches Organ, eine Störung seiner Funktionen korreliert mit Morbidität und Mortalität. Durch seine zentrale Stellung im Organ-Crosstalk hat jede Dysfunktion des Darms wesentliche Auswirkungen auf andere intra- und extraabdominelle Organe. Der Intestinaltrakt ist die wichtigste Quelle endogen auftretender Infektionen und bestimmt den inflammatorischen Status des Organismus. Das Darmversagen ist Teil des Multiorgandysfunktionssyndroms. Wichtigster Mechanismus der Entstehung endogener Infektionen ist die intestinale Translokation von Keimen. Eine Dysbiose und Schädigung der intestinalen Mukosa führt zu einer Störung der intestinalen Barrierefunktion, erhöht die Permeabilität und begünstigt eine Translokation („Leaky-gut-Hypothese“). Ein weiterer wichtiger Mechanismus der Organinteraktionen ist die Erhöhung des intraabdominellen Drucks. Eine intraabdominelle Hypertension führt zu einer weiteren Schädigung des Darms, zu einer Verstärkung der Translokation und Inflammation sowie zur Beeinträchtigung anderer Organsysteme wie der Niere, des Kreislaufs und der Lunge. Die Aufrechterhaltung bzw. Wiederherstellung der intestinalen Funktionen muss ein Ziel jeder Intensivtherapie sein. Wichtigste Maßnahme ist eine frühe enterale Ernährung. Andere Maßnahmen sind die Aufrechterhaltung der Motilität und die Modulation des intestinalen Mikrobioms. Eine intraabdominelle Hypertension muss konsequent durch eine individuell adaptierte Infusionstherapie, Lagerung des Patienten, Medikamentengabe (abdominelle Compliance) und Dekompression (durch Sonden, endoskopisch oder in schweren Fällen auch chirurgisch) behandelt werden.
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Metadaten
Titel
Intestinaler Crosstalk
Der Darm als Motor des Multiorganversagens
verfasst von
Univ.-Prof. Dr. Wilfred Druml
Publikationsdatum
17.01.2019
Verlag
Springer Vienna
Erschienen in
Wiener klinisches Magazin / Ausgabe 1/2019
Print ISSN: 1869-1757
Elektronische ISSN: 1613-7817
DOI
https://doi.org/10.1007/s00740-019-0269-y