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Erschienen in: Die Anaesthesiologie 5/2011

01.05.2011 | Intensivmedizin

Volumentherapie in der Intensivmedizin

verfasst von: PD. Dr. B. Nohé, A. Ploppa, V. Schmidt, K. Unertl

Erschienen in: Die Anaesthesiologie | Ausgabe 5/2011

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Zusammenfassung

Die Volumensubstitution ist ein wesentlicher Bestandteil der Intensivtherapie. Sowohl die Menge des infundierten Volumens, seine Zusammensetzung als auch der Zeitpunkt der Substitution scheinen die Morbidität und Letalität kritisch kranker Patienten zu beeinflussen. Während eine restriktive Volumenstrategie bei kreislaufinstabilen Patienten das Risiko einer Gewebeminderperfusion mit Gewebehypoxie mit sich bringt, begünstigt eine liberale Volumensubstitution bei intakter Gewebeperfusion eine vermeidbare Hypervolämie mit interstitiellen Ödemen und entsprechenden Organfunktionsstörungen. Bislang konnte angesichts fehlender „outcome“-basierter Evidenz keiner der beiden Strategien ein eindeutiger Vorteil zugeordnet werden. Um dem stark variierenden Sauerstoff- (O2)-Bedarf kritisch kranker Patienten gerecht zu werden, wird daher eine bedarfsadaptierte Volumenstrategie empfohlen, die sich am Nachweis einer gefährdeten Gewebeperfusion und der individuellen Volumenreagibilität orientieren sollte. Aufgrund ihrer zeitabhängigen Effektivität zur Korrektur einer Gewebehypoxie sollte die Vorlast möglichst frühzeitig optimiert werden. Ob hierfür kolloidale oder kristalline Lösungen geeigneter sind, ist weiterhin Gegenstand kontroverser Diskussionen. Ein zeitlich limitierter Einsatz von kolloidalen Lösungen in der initialen Phase der Gewebeminderperfusion scheint jedoch dazu beizutragen, deren größeren Volumeneffekt bei Hypovolämie nutzen zu können und mögliche Nebenwirkungen so weit wie möglich zu vermeiden.
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Metadaten
Titel
Volumentherapie in der Intensivmedizin
verfasst von
PD. Dr. B. Nohé
A. Ploppa
V. Schmidt
K. Unertl
Publikationsdatum
01.05.2011
Verlag
Springer-Verlag
Erschienen in
Die Anaesthesiologie / Ausgabe 5/2011
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI
https://doi.org/10.1007/s00101-011-1860-9

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