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Ethik und Palliativmedizin in Intensiv- und Beatmungsmedizin

Ethics and palliative medicine in intensive care and ventilation medicine

  • Leitthema
  • Published:
Der Pneumologe Aims and scope

Zusammenfassung

Ethik und Palliativmedizin besitzen einen hohen Stellenwert in der heutigen Zeit. Das gilt neben der Onkologie zunehmend auch für die Intensivmedizin und klinische sowie außerklinische Beatmungstherapie. Vor allem die große Zahl invasiv beatmeter Patienten mit Weaning-Versagen und ggf. invasiver außerklinischer Beatmung hat zu einer deutlichen Fokussierung auf diese zwar lebenserhaltende, aber eventuell auch ungewollt lebensverlängernde Therapie geführt. Neben technisch Machbarem rücken die Perspektive des Patienten und seiner Familie immer mehr in den Vordergrund. Gefragt ist hierbei palliativmedizinische Kompetenz, um den Patientenwillen zu eruieren und anschließend umzusetzen, auch wenn das einen Therapierückzug oder gar -abbruch bedeutet. Dem Begriff „Therapiezieländerung“ kommt in dieser Situation eine zunehmende Bedeutung zu. Im außerklinischen Bereich ist die Etablierung palliativmedizinischer Strukturen für chronisch kritisch kranke Patienten vor allem mit dem Symptom Atemnot von entscheidender Bedeutung, um durch frühzeitige Intervention in stabilen Krankheitsstadien das weitere Vorgehen zusammen mit dem Patienten zu planen und damit ungewollte Langzeitbeatmungen zu vermeiden.

Abstract

Ethics and palliative care have a growing impact at the present time. This is true not only in oncology but also increasingly more for intensive care medicine and home mechanical ventilation. In particular, the large number of invasively ventilated patients with weaning failure has led to a clear focus on this both life-sustaining and possibly undesired life-prolonging treatment. In addition to what is technically feasible, the perspectives of patients and their families are coming more into focus. Palliative care skills are needed to elicit and adequately react to the patient’s wishes, even if that leads to therapy withdrawal or withholding treatment. Changing the aim of the treatment is becoming increasingly more important. In the non-clinical area of home mechanical ventilation the establishment of palliative care structures for chronically critically ill patients mainly suffering from dyspnea are crucially needed. Early intervention in and counseling of patients with chronic diseases is helpful in avoiding futile long-term invasive mechanical ventilation.

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Authors and Affiliations

  1. Klinik für Intensivmedizin, Schlaf- und Beatmungsmedizin, Asklepios Fachkliniken München-Gauting, Robert-Koch-Allee 2, 82131, Gauting, Deutschland

    J. Geiseler

  2. Klinik für Pneumologie Intensiv- und Schlafmedizin, KRH Klinikum Siloah-Oststadt-Heidehaus, Hannover, Deutschland

    B. Schönhofer

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  1. J. Geiseler
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Correspondence to J. Geiseler.

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J. Geiseler und B. Schönhofer geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Geiseler, J., Schönhofer, B. Ethik und Palliativmedizin in Intensiv- und Beatmungsmedizin. Pneumologe 13, 104–112 (2016). https://doi.org/10.1007/s10405-015-0021-2

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  • DOI: https://doi.org/10.1007/s10405-015-0021-2

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