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Präkonditionierung von Lunge und Kreislauf vor viszeral- oder thoraxchirurgischen Eingriffen

Preconditioning of the lungs and circulation before visceral and thoracic surgical interventions

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Zusammenfassung

Hintergrund

Die Einschätzung des perioperativen Risikos spielt insbesondere in Anbetracht des demographischen Wandels eine entscheidende Rolle in der chirurgischen Indikationsstellung. Auch vor diesem Hintergrund sind heute Prähabilitationskonzepte zur Senkung des postoperativen Risikos zunehmend von Bedeutung.

Ziel der Arbeit

Darstellung der aktuellen Empfehlungen zur präoperativen Diagnostik bei thoraxchirurgischen Eingriffen sowie Prähabilitationskonzepte und deren praktischer Anwendbarkeit.

Material und Methoden

Es erfolgte eine selektive Literaturübersicht durch Recherche in den elektronischen Datenbanken PubMed, Cochrane Library und ISRCTN sowie in den aktuellen Leitlinien des American College of Chest Physicians (ACCP) und der European Society of Thoracic Surgery (ESTS).

Ergebnisse

Die Präkonditionierung umfasst die konservative Therapie von Grunderkrankungen, Rauchentwöhnung und Prähabilitation. Prähabilitation ist ein immer weiter in den klinischen Alltag drängendes Konzept, wenngleich die Evidenzlage aufgrund sehr heterogener Studienlage nur eingeschränkt vorhanden ist. Insgesamt gibt es jedoch die Tendenz zu positiven Effekten auf Lebensqualität und postoperative Komplikationen sowie Rekonvaleszenz.

Diskussion

Neben der präoperativen Diagnostik zur Einschätzung des perioperativen Risikos ist auch eine effektive Präkonditionierung der Patienten erforderlich. Hierzu ist ein interdisziplinärer Ansatz unter Einbezug von Anästhesie, Pneumologie, Psychotherapie und Physiotherapie notwendig. Neben der konservativ-medikamentösen Optimierung gewinnen Prähabilitationskonzepte an Bedeutung und werden sich sicherlich im klinischen Alltag etablieren. Von chirurgischer Seite dienen minimal-invasive Zugänge und parenchymsparende Resektionen ebenfalls der Risikoreduktion.

Abstract

Background

Estimation of the perioperative risk plays a decisive role in the surgical indications, particularly in view of the demographic change. For this reason, prehabilitation concepts for reducing perioperative risk nowadays play an increasingly important role.

Objective

Presentation of the current recommendations for preoperative diagnostics in thoracic surgical interventions as well as existing prehabilitation concepts and their practical applicability.

Material and methods

A selective review of the literature was carried out by searching the electronic databases PubMed, Cochrane Library and ISRCTN, including the guidelines of the American College of Chest Physicians (ACCP) and the European Society of Thoracic Surgery (ESTS).

Results

Preconditioning includes the conservative treatment of underlying diseases, smoking cessation and prehabilitation. Prehabilitation is an increasingly pressing concept in routine clinical practice, even though the evidence is limited due to the very heterogeneous study situation. Overall, however, there is a tendency for positive effects on the quality of life and postoperative complications as well as convalescence.

Conclusion

In addition to preoperative diagnostics to assess the perioperative risk, effective preconditioning of patients is also necessary. For this an interdisciplinary approach including anesthesia, pneumology, psychotherapy and physiotherapy is necessary. In addition to the conservative medicinal optimization, prehabilitation concepts are gaining in importance and will certainly become established in routine clinical practice. From the surgical perspective, minimally invasive approaches and parenchyma-sparing resections also serve to reduce risks.

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Authors and Affiliations

  1. Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland

    T. Möller, T. Becker & J.-H. Egberts

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  1. T. Möller
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  2. T. Becker
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  3. J.-H. Egberts
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Correspondence to T. Möller.

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Interessenkonflikt

T. Möller, T. Becker und J.-H. Egberts geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Möller, T., Becker, T. & Egberts, JH. Präkonditionierung von Lunge und Kreislauf vor viszeral- oder thoraxchirurgischen Eingriffen. Chirurg 90, 529–536 (2019). https://doi.org/10.1007/s00104-019-0943-z

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  • DOI: https://doi.org/10.1007/s00104-019-0943-z

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