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Die Anaesthesiologie
Erschienen in: Der Anaesthesist 6/2018

22.05.2018 | Transthorakale Echokardiografie | Originalien

Metaanalysen zur Messgenauigkeit nichtinvasiver hämodynamischer Überwachungstechnologien bei Erwachsenen

verfasst von: PD Dr. med. G. Pestel, K. Fukui, M. Higashi, I. Schmidtmann, C. Werner

Erschienen in: Die Anaesthesiologie | Ausgabe 6/2018

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Zusammenfassung

Nichtinvasive Überwachungstechniken sollen eine exakte, verlässliche, bettseitig verfügbare, kontinuierliche, einfach zu bedienende und kostengünstige Darstellung vitaler Patientenparameter in Anästhesiologie, Intensivmedizin und Notfallmedizin garantieren und dabei für die betroffenen Patienten ein minimales Risiko- bzw. Nebenwirkungsprofil besitzen. Vorbild ist die Einführung der Pulsoxymetrie, die sich weltweit zur nichtinvasiven Überwachung der Oxygenierung durchsetzen konnte. Eine entsprechende nichtinvasive Überwachung der Hämodynamik bzw. der Perfusion könnte die anästhesiologische Behandlung noch besser auf die Bedürfnisse des individuellen Einzelfalls optimieren. In den vergangenen Jahren wurde eine Reihe nichtinvasiver Überwachungstechniken (für die Herzzeitvolumen(HZV)-/Schlagvolumen(SV)-Messung: suprasternaler Dopplerultraschall, modifizierte Windkesselfunktion, Pulswellentransitzeit, Radialarterientonometrie, thorakale Bioimpedanz, endotracheale Bioimpedanz, Bioreaktanz, partielle CO2-Rückatmung; für die Vorhersage der Volumenreagibilität: fotoelektrische Fingerblutvolumenmessung, beatmungsbedingte Schwankung der Plethysmographiekurve) vorgestellt. Eine kritische Übersicht und Bewertung dieser gutachterlich geprüften Veröffentlichungen liegen bislang nicht vor. Um bei Durchführung einer Metaanalyse eine akzeptable Vergleichbarkeit zu gewährleisten, wurden daher Untersuchungen mit jeweils gleichartiger Studien- bzw. Referenzmethode zusammengefasst und betrachtet. Primäres Evaluationskriterium war das Vorliegen einer Bland-Altman-Analyse zum Vergleich von Mittelwert und Streuung im Methodenvergleich nichtinvasive Technologie vs. Referenzmethode. Für die meisten nichtinvasiven Überwachungstechniken wurde im Vergleich zur Referenztechnik eine breite Streuung der gefundenen Messwerte festgestellt. Daher erscheint eine gleichwertige Ersetzbarkeit gegenüber invasiven Überwachungstechniken hinsichtlich der Verlässlichkeit des gemessenen Einzelwerts derzeit nicht gegeben. Gegenwärtige Schwerpunkte der klinischen Forschung sind der Stellenwert nichtinvasiver Überwachungstechniken für eine Trendüberwachung, Alternativen zum Finger als Lokalisation zum Abgreifen von Rohsignalen bei der nichtinvasiven Überwachung und die Entwicklung von Fluss-Zeit-basierten Messmethoden hämodynamischer Überwachungsparameter.
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Metadaten
Titel
Metaanalysen zur Messgenauigkeit nichtinvasiver hämodynamischer Überwachungstechnologien bei Erwachsenen
verfasst von
PD Dr. med. G. Pestel
K. Fukui
M. Higashi
I. Schmidtmann
C. Werner
Publikationsdatum
22.05.2018
Verlag
Springer Medizin
Erschienen in
Die Anaesthesiologie / Ausgabe 6/2018
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI
https://doi.org/10.1007/s00101-018-0452-3

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Neu im Fachgebiet AINS

23.04.2024 | Appendizitis | Nachrichten

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 | Leitsymptom Rückenschmerzen | Nachrichten

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 | Operationsvorbereitung | Nachrichten

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

23.04.2024 | Pankreaskarzinom | Nachrichten

S3-Leitlinie zu Pankreaskrebs aktualisiert
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