Steinlechner B, Zimpfer Daniel, Schiferer Arno, Heinrich Nikolaus, Schlöglhofer Thomas, Rajek Angela, Dworschak Martin, Hiesmayr Michael
Klinische Abteilung für Herz-, Thorax-, Gefäßchirurgische Anästhesie und Intensivmedizin, Universitätsklinik für Anästhesie, Allgemeine Intensivmedizin und Schmerztherapie, Währinger Gürtel 18-20, 1090, Wien, Österreich.
Klinische Abteilung für Herzchirurgie, Universitätsklinik für Chirurgie, Währinger Gürtel 18-20, 1090 Wien, Österreich.
Med Klin Intensivmed Notfmed. 2015 Sep;110(6):421-30. doi: 10.1007/s00063-015-0063-6. Epub 2015 Aug 28.
Apart from heart transplantation, implantation of a left ventricular assist device (LVAD) is the only established surgical treatment for therapy-refractory terminal left heart failure, The specific intensive care unit (ICU) management of these patients depends on the reason for the ICU admission and requires understanding of the characteristic hemodynamics of non-pulsatile LVADs as well as of the inherent problems. Knowledge about the specific features in hemodynamic monitoring, understanding of pump characteristics, management of anticoagulation and hemostasis and the handling of problems, such as right heart failure, aortic valve insufficiency and infections is essential. The management of unconscious LVAD patients can be challenging. It requires a sophisticated transthoracic and transesophageal echocardiography (TTE/TEE) examination, targeted laboratory diagnostics and consideration of possible alternative diagnoses. Professional interdisciplinary cooperation and exchange of current knowledge is crucial.
除心脏移植外，植入左心室辅助装置（LVAD）是治疗难治性终末期左心衰竭唯一已确立的外科治疗方法。这些患者在重症监护病房（ICU）的具体管理取决于入住ICU的原因，需要了解非搏动性LVAD的特征性血流动力学以及内在问题。掌握血流动力学监测的具体特点、了解泵的特性、抗凝和止血管理以及处理诸如右心衰竭、主动脉瓣关闭不全和感染等问题至关重要。LVAD无意识患者的管理具有挑战性。这需要进行复杂的经胸和经食管超声心动图（TTE/TEE）检查、有针对性的实验室诊断以及考虑可能的其他诊断。专业的多学科合作和当前知识的交流至关重要。
