{"id":2381,"date":"2016-11-07T04:48:20","date_gmt":"2016-11-07T03:48:20","guid":{"rendered":"http:\/\/news-papers.eu\/?p=2381"},"modified":"2016-11-07T08:19:21","modified_gmt":"2016-11-07T07:19:21","slug":"rescue-icp-studie","status":"publish","type":"post","link":"http:\/\/news-papers.eu\/?p=2381","title":{"rendered":"RESCUE-ICP Studie"},"content":{"rendered":"<p><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"2630\" data-permalink=\"http:\/\/news-papers.eu\/?attachment_id=2630\" data-orig-file=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/11\/NCH-OP.jpg?fit=1200%2C1600\" data-orig-size=\"1200,1600\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;Processed with Snapseed.&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;Processed with Snapseed.&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"OP\" data-image-description=\"&lt;p&gt;OP&lt;\/p&gt;\n\" data-image-caption=\"\" data-large-file=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/11\/NCH-OP.jpg?fit=768%2C1024\" class=\"wp-image-2630 alignright\" src=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/11\/NCH-OP.jpg?resize=203%2C271\" alt=\"Processed with Snapseed.\" width=\"203\" height=\"271\" srcset=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/11\/NCH-OP.jpg?resize=225%2C300 225w, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/11\/NCH-OP.jpg?resize=768%2C1024 768w, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/11\/NCH-OP.jpg?resize=750%2C1000 750w, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/11\/NCH-OP.jpg?w=1200 1200w\" sizes=\"auto, (max-width: 203px) 100vw, 203px\" \/><\/p>\n<p style=\"text-align: justify;\">Am 07.09.2016 wurde im New Englang Journal of Medicine der <strong>RESCUE-ICP<\/strong> (Randomised Evaluation of Surgery with Craniectomy for Uncontrollable Elevation\u00a0of Intracranial Pressure) Studie\u00a0publiziert:<\/p>\n<blockquote><p><strong>Hutchinson PJ, et al. Trial of Decompressive Craniectomy\u00a0for Traumatic Intracranial Hypertension. NEJM 2016;\u00a0DOI: 10.1056\/NEJMoa1605215<\/strong><\/p><\/blockquote>\n<p>und von einem Editorial begleitet:<\/p>\n<blockquote><p><strong>Shutter L, et al. Intracranial Pressure Rescued by Decompressive Surgery\u00a0after Traumatic Brain Injury. NEJM 2016;\u00a0DOI: 10.1056\/NEJMe1609722<\/strong><\/p><\/blockquote>\n<hr \/>\n<p style=\"text-align: justify;\">Das Sch\u00e4del-Hirn-Trauma (SHT) hat einen der h\u00f6chsten Effekte auf die Letalit\u00e4t beim Trauma. Insbesondere ein erh\u00f6hter intrakranieller Druck f\u00fchrt zu einer hohen Sterblichkeit als Folge einer sekund\u00e4ren Hirnsch\u00e4digung. Die Wertigkeit einer Hemicraniektomie (also die Entfernung einer einseitigen Sch\u00e4delkalotte) oder eine bifrontale Craniektomie ist bisher nicht abschlie\u00dfend gekl\u00e4rt.<\/p>\n<p style=\"text-align: justify;\">Im RESCUE-ICP Trial wurden nun von 2004 bis\u00a02014, 408 Patienten im Alter zwischen 10-65 Jahren entweder zu einer rein medikament\u00f6sen Hirndrucktherapie mit einem Barbituratkoma als h\u00f6chster Eskalationsstufe oder zur mdeikament\u00f6sen Hirndrucktherapie mit einer Hemikraniektomie anstelle der Barbiturate randomisiert, wenn ein therapierefrakt\u00e4rer intracerebraler Druck (ICP)\u00a0&gt;25 mmHg f\u00fcr 1-12 h vorlag. In der Initialphase vor Randomisierung erhielten alle Patienten die gleiche Versorgung inkl. Oberk\u00f6rperhochlagerung, Beatmung, Sedierung, Analgesie, Muskelrelaxierung (optional), Monitoring (inkl. ZVD, invasive Druckmessung, ICP-Messung) und ggf. ein optionale weitere Behandlung mit Ventriculotomie, Katcholaminen, Mannitol, Hypertone Kochsalzl\u00f6sung, Schleifendiuretika, Hypothermie. \u00a0Nach 1-12 h erfolgte bei nicht beherrschbaren Hirndruck von &gt;25 mmHg dann eine Eskalation zur Craniektomie oder ein Barbitruatkoma.\u00a0Eine Hemicanriektomie wurde in 37% und eine bifrontale Craniektomie in 63% durchgef\u00fchrt.<\/p>\n<p style=\"text-align: justify;\">Das neurologische Behandlungsergebnis gemessen anhand der erweiterten Glasgow Outcome Skala (GOS-E) in beiden Untersuchungsarmen unterschied sich deutlich nach 6 Monaten in der Dekraniektomie vs. konservativen medikamenten Therapiegruppe:<\/p>\n<ul>\n<li>Letalit\u00e4t: 26,9 vs. 48.9%<\/li>\n<li>vegetativer neurologischer Zustand: 8,5\u00a0vs.\u00a02.1%<\/li>\n<li>moderate Behinderung: 23,4 vs. 19,7<\/li>\n<li>gute Erholung: 4,0\u00a0vs.\u00a06,9%.<\/li>\n<\/ul>\n<p><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"2391\" data-permalink=\"http:\/\/news-papers.eu\/?attachment_id=2391\" data-orig-file=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/11\/Bildschirmfoto-2016-09-10-um-17.47.21.png?fit=1398%2C496\" data-orig-size=\"1398,496\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"bildschirmfoto-2016-09-10-um-17-47-21\" data-image-description=\"\" data-image-caption=\"\" data-large-file=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/11\/Bildschirmfoto-2016-09-10-um-17.47.21.png?fit=1024%2C363\" class=\"alignnone wp-image-2391\" src=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/11\/Bildschirmfoto-2016-09-10-um-17.47.21.png?resize=736%2C260\" alt=\"bildschirmfoto-2016-09-10-um-17-47-21\" width=\"736\" height=\"260\" srcset=\"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/11\/Bildschirmfoto-2016-09-10-um-17.47.21.png?resize=300%2C106 300w, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/11\/Bildschirmfoto-2016-09-10-um-17.47.21.png?resize=768%2C272 768w, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/11\/Bildschirmfoto-2016-09-10-um-17.47.21.png?resize=1024%2C363 1024w, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/11\/Bildschirmfoto-2016-09-10-um-17.47.21.png?resize=750%2C266 750w, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/11\/Bildschirmfoto-2016-09-10-um-17.47.21.png?w=1398 1398w\" sizes=\"auto, (max-width: 736px) 100vw, 736px\" \/><\/p>\n<p>Nach 12 Monaten lagen folgende Ergebnisse vor:<\/p>\n<ul>\n<li>Letalit\u00e4t: 30,4 vs. 52,0%<\/li>\n<li>vegetativer neurologischer Zustand: 6,2 vs. 1.7%<\/li>\n<li>moderate Behinderung: 22,2 vs. 20,1%<\/li>\n<li>gute Erholung: 9,8 vs. 8,4%.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Patienten, die sich einer Hemikraniektomie unterziehen mussten, wiesen weniger Stunden mit einem erh\u00f6hten Hirndruck im Vergleich zu Patienten der medikament\u00f6sen Therapiegruppe auf\u00a0(Median: 5 vs. 17 Stunden; p&lt;0,001). Aber die operativ versorgten Patienten wiesen eine h\u00f6here Rate an Komplikationen auf\u00a0(16,3 vs. 9,2%, p=0,03). W\u00e4hrend bei 37% der Patienten der medikament\u00f6sen Therapiegruppe im Verlauf noch eine Craniektomie durchgef\u00fchrt werden musste um den Hirndruck zu senken, war ein Barbituratkoma in der Craniektomiegruppe nur in 9% notwendig.<\/p>\n<p style=\"text-align: justify;\">Die Autoren schlussfolgerten aus der Untersuchung, dass Patienten 6 Monate nach dem Ereignis nach dekompressiver Craniektomie eine geringe Mortalit\u00e4t, aber eine h\u00f6here Rate an vegetativen Zust\u00e4nden oder Abh\u00e4ngigkeitszust\u00e4nden aufwiesen im Vergleich zur medikament\u00f6sen Therapie. Das Verh\u00e4ltnis einer moderaten Behinderung und eines guten neurologischen Behandlungsergebnis blieben vergleichbar. Damit sterben weniger Patienten nach Craniektomie, aber deutlich mehr Patienten weisen eine schwere Behinderung oder ein Abh\u00e4ngigkeit von andern Monate nach dem lebensrettenden Eingriff auf.<\/p>\n<hr \/>\n<p>Registriert ist die Untersuchung bei:\u00a0<strong><a href=\"http:\/\/www.isrctn.com\/ISRCTN66202560\" target=\"_blank\">http:\/\/www.isrctn.com\/ISRCTN66202560<\/a><\/strong><\/p>\n<p>Ein Video findet sich hier: <strong><a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1605215?query=featured_home\" target=\"_blank\">Video<\/a><\/strong><\/p>\n<p>Weitere Blog-Stimmen finden Sie hier:\u00a0<strong><a href=\"http:\/\/lifeinthefastlane.com\/lifting-lid-proven-therapy\/\" target=\"_blank\">http:\/\/lifeinthefastlane.com\/lifting-lid-proven-therapy\/<\/a><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Am 07.09.2016 wurde im New Englang Journal of Medicine der RESCUE-ICP (Randomised Evaluation of Surgery with Craniectomy for Uncontrollable Elevation\u00a0of Intracranial Pressure) Studie\u00a0publiziert: Hutchinson PJ, et al. Trial of Decompressive [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":2630,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"__cvm_playback_settings":[],"__cvm_video_id":"","jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":true,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"_wpas_customize_per_network":false},"categories":[6],"tags":[518,519,517],"class_list":["post-2381","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-trauma","tag-dekraniektomie","tag-konservative-hirndrucktherapie","tag-rescue-icp-trail"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2016\/11\/NCH-OP.jpg?fit=1200%2C1600","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p7fR2g-Cp","jetpack-related-posts":[{"id":9225,"url":"http:\/\/news-papers.eu\/?p=9225","url_meta":{"origin":2381,"position":0},"title":"Hypertone Kochsalzl\u00f6sung oder Mannitol zur Hirndrucksenkung?","author":"Michael Bernhard","date":"April 20, 2019","format":false,"excerpt":"Ein Beitrag von PD Dr. J\u00fcrgen Knapp, Schweiz\/Bern: Welche Infusionsl\u00f6sung ist besser geeignet zur Hirndrucksenkung beim Sch\u00e4del-Hirn-Trauma? 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