Plasmapherese und Immunadsorption auf der Intensivstation
Tóm tắt
In den letzten 40 Jahren haben sich die Technologie und die Indikationsstellung des therapeutischen Plasmaaustausches kontinuierlich weiterentwickelt. Mit zunehmender Inzidenz von Autoimmunerkrankungen, wegen mangelnder Therapieoptionen und auch aufgrund ökonomischer Überlegungen wurden immer selektivere Techniken des Plasmaaustausches entwickelt. Die Immunadsorption ermöglicht heute die spezifische extrakorporale Elimination pathogener Immunglobuline. Für den Einsatz der Plasmapherese und der Immunadsorption liegen zunehmend Daten für diverse Autoimmunerkrankungen auch und gerade bei kritisch kranken Patienten vor. Diese Evidenz stützt sich zum Teil auf Fallbeschreibungen und kleine Fallserien; randomisierte, kontrollierte Studien fehlen bisher bei vielen Krankheitsbildern. Dennoch werden die Plasmapherese und insbesondere die Immunadsorption zunehmend auch auf der Intensivstation eingesetzt, da sie eine große therapeutische Chance für kritisch kranke Patienten implizieren und in der Anwendung relativ sicher und nebenwirkungsarm sind, wenn eine ausreichende fachliche Expertise und ein adäquates Monitoring sichergestellt sind.
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