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Anwendung intensivmedizinischer Ma\u00dfnahmen zur Aufrechterhaltung der Organfunktionen bei unmittelbar bevorstehendem bzw. eingetretenem irreversiblen Hirnfunktionsausfall (IHA). Hierdurch soll die M\u00f6glichkeit einer Organspende bei Personen aufrechterhalten werden, wenn eine Bereitschaft zur Spende erkl\u00e4rt wurde oder diesbez\u00fcglich Unsicherheiten bestehen. Hinsichtlich der intensivmedizinischen Inhalte existiert in Deutschland bisher keine evidenzbasierte Leitlinie. Die vorliegende Arbeit soll daher eine Orientierungshilfe f\u00fcr die organprotektive Intensivtherapie bzw. Anwendung organfunktionserhaltender Ma\u00dfnahmen bei Erwachsenen mit schwerer Hirnsch\u00e4digung und unmittelbar bevorstehendem bzw. eingetretenem IHA bieten.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Material und Methoden<\/jats:title>\n            <jats:p>Grundlage dieser \u00dcbersichtsarbeit waren englisch- und deutschsprachige Beitr\u00e4ge in entsprechenden Datenbanken (PubMed\/Medline) sowie internationale Leitlinien und Handlungsempfehlungen.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Ergebnisse<\/jats:title>\n            <jats:p>Innerhalb des Kontinuums vom unmittelbar bevorstehenden bis zum festgestellten IHA und der sich anschlie\u00dfenden Phase ergeben sich pathophysiologische Besonderheiten, die Implikationen f\u00fcr die organprotektive Intensivtherapie und entsprechende Ma\u00dfnahmen zur Aufrechterhaltung der Organfunktionen haben. Diese beziehen sich v.\u202fa. auf die h\u00e4modynamische Situation, die Lungenfunktion, das endokrine System und infektiologische Komplikationen. Dar\u00fcber hinaus existieren Ma\u00dfnahmen, die auf den Schutz von Organen nach deren Entnahme abzielen. Auf der Basis von Kohorten\u2011\/Register- bzw. wenigen randomisierten Studien konnten Ma\u00dfnahmen in bestimmten Situationen eingegrenzt werden wie die i.v.-Gabe von Vasopressin und Glukokortikoiden sowie die konsequente lungenprotektive Beatmung mit Rekrutierungsman\u00f6vern, die mit einer Verbesserung der H\u00e4modynamik und Lungenfunktion einherzugehen scheinen. Diesen Beobachtungen ist jedoch eine insgesamt geringe Evidenz gemeinsam, und Detailfragen, beispielsweise hinsichtlich des optimalen Zeitpunkts einer Vasopressin- bzw. Glukokortikoidgabe, sind ungekl\u00e4rt. Dar\u00fcber hinaus existierten anhaltend kontrovers diskutierte Ma\u00dfnahmen wie die Substitution von Schilddr\u00fcsenhormonen, die niederschwellige Insulingabe und die Anwendung von Dopamin.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Diskussion<\/jats:title>\n            <jats:p>Aus der vorhandenen Literatur lassen sich Empfehlungen f\u00fcr die Anwendung organprotektiver bzw. organfunktionserhaltender intensivmedizinischer Ma\u00dfnahmen im zeitlichen Zusammengang mit dem IHA allenfalls bei Vorliegen bestimmter Kontextfaktoren wie einer instabilen h\u00e4modynamischen Situation ableiten. In der klinischen Praxis sollten daher allgemeine intensivmedizinische Standards zur Anwendung kommen. Notwendig sind Forschungsinitiativen, die sowohl spezifische intensivmedizinische Inhalte als auch Versorgungsaspekte ber\u00fccksichtigen. Hierf\u00fcr bieten sich randomisierte Studien ebenso wie die Weiterentwicklung des Deutschen Nationalen Transplantationsregisters an, auf deren Grundlage entsprechende Erkenntnisse generiert werden k\u00f6nnten.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00101-025-01573-y","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T08:52:34Z","timestamp":1756111954000},"page":"587-602","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Organprotektive Intensivtherapie und intensivmedizinische Ma\u00dfnahmen bei Personen mit schwerer Hirnsch\u00e4digung und unmittelbar bevorstehendem bzw. eingetretenem irreversiblen Hirnfunktionsausfall","Intensive care strategies for organ protection in patients with severe brain damage and imminent or confirmed irreversible brain death"],"prefix":"10.1007","volume":"74","author":[{"given":"Dominik","family":"Michalski","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorenz","family":"Weidhase","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felix","family":"Pfeifer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan S\u00f6nke","family":"Englbrecht","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Klaus","family":"Hahnenkamp","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Svitlana","family":"Ziganshyna","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,8,25]]},"reference":[{"key":"1573_CR1","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1007\/s00063-018-0513-z","volume":"114","author":"RA Organspende","year":"2019","unstructured":"Organspende\u00a0RA (2019) Update 2019. 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