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Die Behandlung des hämorrhagischen Schocks

Neue Therapieoptionen

Treatment of hemorrhagic shock

New therapy options

  • Leitthema
  • Published:
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Zusammenfassung

Der hämorrhagische Schock wird mit Gegenregulationsmechanismen des Organismus beantwortet, die zumindest ein temporäres Überleben ermöglichen. Hier können neue Therapiestrategien ansetzen. Die Zukunft der Schockbehandlung wird vom wissenschaftlichen Erkenntnisgewinn und der Bereitschaft der Ärzte abhängen, etablierte Therapiekonzepte zu aktualisieren. Die vier Hauptzielgrößen der zukünftigen Schockbehandlung sind: Blutungskontrolle durch lokale blutstillende Maßnahmen und eine Optimierung des Gerinnungssystems; Erhöhung des intravaskulären Volumens durch Ausschöpfung venöser Blutreserven (Vermeidung von Fehlern bei der kontrollierten Beatmung, Einsatz alternativer Spontan- bzw. Beatmungskonzepte, Infusion von künstlichen Sauerstoffträgern); pharmakologische Interaktion mit endogenen Kompensations- und Dekompensationsmechanismen (Gabe von Arginin-Vasopressin und ATP-sensitiven Kalium-Kanal-Blockern); Anwendung protektiver Maßnahmen (Induktion einer moderaten Hypothermie). Ultimative Zukunftsvision in der Behandlung des vital bedrohlichen hämorrhagischen Schocks ist die „suspended animation“ im Sinne einer postponierten Wiederbelebung nach Protektion vitaler Organsysteme.

Abstract

The future of shock treatment depends on the importance of scientific results, and the willingness of physicians to optimize, and to reconsider established treatment protocols. There are four major potentially promising approaches to advanced trauma life support. First, control of hemorrhage by administration of local hemostatic agents, and a better, target-controlled management of the coagulation system. Second, improving intravascular volume by recruiting blood from the venous vasculature by preventing mistakes during mechanical ventilation, and by employing alternative spontaneous (i.e. use of the inspiratory threshold valve) or artificial ventilation strategies. In addition, artificial oxygen carriers may improve intravascular volume and oxygen delivery. Third, pharmacologic support of physiologic, endogenous mechanisms involved in the compensation phase of shock, and blockade of pathomechanisms that are known to cause irreversible vasoplegia (arginine vasopressin and KATP channel blockers for hemodynamic stabilization). Fourth, employing potentially protective strategies such as mild or moderate hypothermia. Finally, the ultimate vision of trauma resuscitation is the concept of “suspended animation” as a form of delayed resuscitation after protection of vital organ systems.

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Authors and Affiliations

  1. Universitätsklinik für Anästhesiologie und Allgemeine Intensivmedizin, Medizinische Universität Innsbruck

    W. G. Voelckel M.Sc., A. von Goedecke, D. Fries, A. C. Krismer, V. Wenzel & K. H. Lindner

  2. Universitätsklinik für Anästhesiologie und allgemeine Intensivmedizin, Medizinische Universität, Anichstrasse 35, 6020, Innsbruck, Österreich

    W. G. Voelckel M.Sc.

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  1. W. G. Voelckel M.Sc.
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  2. A. von Goedecke
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  3. D. Fries
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  4. A. C. Krismer
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  5. V. Wenzel
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  6. K. H. Lindner
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Correspondence to W. G. Voelckel M.Sc..

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Voelckel, W.G., von Goedecke, A., Fries, D. et al. Die Behandlung des hämorrhagischen Schocks. Anaesthesist 53, 1151–1167 (2004). https://doi.org/10.1007/s00101-004-0771-4

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  • DOI: https://doi.org/10.1007/s00101-004-0771-4

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