Notfall + Rettungsmedizin

, Volume 13, Issue 4, pp 287–293

Volumenreanimation

Leitthema
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Zusammenfassung

Infusionslösungen sind bedeutende Instrumente in der Hand von Notärzten und Intensivmedizinern. Trotzdem werden sie speziell in der Notfallsituation oft nicht als Medikamente mit Wirkungen und Nebenwirkungen behandelt, also mit genauen therapeutischen Zielvorstellungen gewissenhaft indiziert und exakt dosiert, sondern dem Kreislauf eher pauschal und im Zweifel im Überschuss angeboten. Dies muss nicht von Vorteil für das Gesamt-Outcome des Patienten sein, wenngleich makrohämodynamische Kennzahlen unter diesem etablierten Vorgehen während der präklinischen Reanimationsphase kurzfristig größere Stabilität suggerieren. Potenziell negative Folgen wirken sich erst im weiteren klinischen Verlauf und damit außerhalb des notärztlichen Blickfeldes aus. Dieser Interessenkonflikt führt immer wieder zu nur wenig zielorientierten Diskussionen an der Schnittstelle zwischen Präklinik und Klinik.

Moderne Infusionsmaßnahmen sollten nicht isoliert betrachtet werden, sondern im Gesamtkontext einer Kreislauftherapie, die physiologischen und pathophysiologischen Grundsätzen ebenso gerecht wird wie der individuellen Situation des Patienten. Dies erfordert vom Notarzt genaue Kenntnisse der Physiologie von Kompartimenten und Barrieren im menschlichen Organismus. Zudem ist hohe Flexibilität und ein zeitgemäßes Repertoire zu fordern, das Flüssigkeit von Volumen unterscheidet und die Anwendung von Vasopressoren und Inotropika beinhaltet.

Schlüsselwörter

Flüssigkeit Hypovolämie Kreislauftherapie Vasopressoren Volumen 

Volume resuscitation

Abstract

Infusion solutions are important and potent therapeutic agents in the hands of emergency or intensive care physicians. Nevertheless, especially in emergency situations they are often not treated as drugs with effects and side effects and therefore diligently indicated with exact therapeutical objectives, but globally and in doubt superfluously ”offered” to the circulation. This must not be an advantage for the overall patient outcome, albeit macrohaemodynamic parameters suggest a higher short-term stability under this established procedure. Potential negative effects, however, develop first during hospitalization and, therefore, outside the focus of the emergency physician. This conflict of interest frequently causes non-purposeful discussions at the interface between the preclinical and clinical phases.

Modern infusion therapies cannot be viewed in isolation but rather as a complete therapeutic concept for the circulation which must meet the requirements of physiological and pathophysiological basic principles, as well as the individual situation of the patient. This necessitates exact knowledge of fluid compartments and barriers within the human organism by the emergency physician. Moreover, high flexibility and an up-to-date repertoire of procedures which differentiate between fluid and volume are needed, including the use of vasopressors and inotropics.

Keywords

Circulation therapy Fluid Hypovolemia Vasopressors Volume 

Literatur

  1. 1.
    (n a) (2005) American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Part 4: adult basic life support. Circulation 112:IV-19–IV-34Google Scholar
  2. 2.
    Blanloeil Y, Baron D, Pinaud M et al (1981) Anaphylactoid shocks induced by infusion of a modified gelatin. Six cases. Anesth Analg (Paris) 38:275–280Google Scholar
  3. 3.
    Boldt J (2007) II. The balanced concept of fluid resuscitation. Br J Anaesth 99:312–315CrossRefPubMedGoogle Scholar
  4. 4.
    Boldt J, Haisch G, Suttner S et al (2002) Effects of a new modified, balanced hydroxyethyl starch preparation (Hextend) on measures of coagulation. Br J Anaesth 89:722–728CrossRefPubMedGoogle Scholar
  5. 5.
    Boldt J, Suttner S, Brosch C et al (2009) The influence of a balanced volume replacement concept on inflammation, endothelial activation, and kidney integrity in elderly cardiac surgery patients. Intensive Care Med 35:462–470CrossRefPubMedGoogle Scholar
  6. 6.
    Chappell D, Jacob M (2009) Die Bedeutung der endothelialen Glykokalyx für die Infusionspraxis in der Notfallmedizin. Notfall Rettungsmed 12:169–175CrossRefGoogle Scholar
  7. 7.
    Chappell D, Jacob M, Becker BF et al (2008) Expedition glycocalyx. A newly discovered „Great Barrier Reef“. Anaesthesist 57:959–969CrossRefPubMedGoogle Scholar
  8. 8.
    Chappell D, Jacob M, Hofmann-Kiefer K et al (2008) A rational approach to perioperative fluid therapy. Anesthesiology 109:723–740CrossRefPubMedGoogle Scholar
  9. 9.
    Dellinger RP, Levy MM, Carlet JM et al (2008) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med 34:17–60CrossRefPubMedGoogle Scholar
  10. 10.
    Entholzner EK, Mielke LL, Calatzis AN et al (2000) Coagulation effects of a recently developed hydroxyethyl starch (HES 130/0.4) compared to hydroxyethyl starches with higher molecular weight. Acta Anaesthesiol Scand 44:1116–1121CrossRefPubMedGoogle Scholar
  11. 11.
    Ertmer C, Rehberg S, Van Aken H, Westphal M (2009) Relevance of non-albumin colloids in intensive care medicine. Best Pract Res Clin Anaesthesiol 23:193–212CrossRefPubMedGoogle Scholar
  12. 12.
    Gunnerson KJ, Saul M, He S, Kellum JA (2006) Lactate versus non-lactate metabolic acidosis: a retrospective outcome evaluation of critically ill patients. Crit Care 10:R22CrossRefPubMedGoogle Scholar
  13. 13.
    Jacob M, Chappell D (2009) Mythen und Fakten der perioperativen Infusionstherapie. Anaesthesie und Intensivmed 50:358–372Google Scholar
  14. 14.
    Jacob M, Chappell D, Hofmann-Kiefer K et al (2007) Determinants of insensible fluid loss. Perspiration, protein shift and endothelial glycocalyx. Anaesthesist 56:747–764CrossRefPubMedGoogle Scholar
  15. 15.
    Jacob M, Chappell D, Rehm M (2007) Clinical update: perioperative fluid management. Lancet 369:1984–1986CrossRefPubMedGoogle Scholar
  16. 16.
    Kozek-Langenecker SA (2005) Effects of hydroxyethyl starch solutions on hemostasis. Anesthesiology 103:654–660CrossRefPubMedGoogle Scholar
  17. 17.
    Lehmann G, Asskali F, Forster H (2002) Severe adverse event following iv administration of 10 ml 6% Dextran60 (0.6 g) in a healthy volunteer. Anaesthesist 51:820–824CrossRefPubMedGoogle Scholar
  18. 18.
    Mauritz W, Schimetta W, Oberreither S, Polz W (2002) Are hypertonic hyperoncotic solutions safe for prehospital small-volume resuscitation? Results of a prospective observational study. Eur J Emerg Med 9:315–319CrossRefPubMedGoogle Scholar
  19. 19.
    Nelson A, Berkestedt I, Schmidtchen A et al (2008) Increased levels of glycosaminoglycans during septic shock: relation to mortality and the antibacterial actions of plasma. Shock 30:623–627CrossRefPubMedGoogle Scholar
  20. 20.
    Rehm M, Haller M, Orth V et al (2001) Changes in blood volume and hematocrit during acute preoperative volume loading with 5% albumin or 6% hetastarch solutions in patients before radical hysterectomy. Anesthesiology 95:849–856CrossRefPubMedGoogle Scholar
  21. 21.
    Rehm M, Orth V, Kreimeier U et al (2000) Changes in intravascular volume during acute normovolemic hemodilution and intraoperative retransfusion in patients with radical hysterectomy. Anesthesiology 92:657–664CrossRefPubMedGoogle Scholar
  22. 22.
    Rehm M, Orth VH, Weninger E et al (2001) Acute „normovolemic“ hemodilution with 3.5% polygel (Haemaccel) for patients in the Wertheim-Meigs-operation. Blood loss of 87% blood volume without perioperative blood transfusion. Anaesthesist 50:580–584CrossRefPubMedGoogle Scholar
  23. 23.
    Schortgen F, Lacherade JC, Bruneel F et al (2001) Effects of hydroxyethyl starch and gelatin on renal function in severe sepsis: a multicentre randomised study. Lancet 357:911–916CrossRefPubMedGoogle Scholar
  24. 24.
    Sirtl C, Laubenthal H, Zumtobel V et al (1999) Tissue deposits of hydroxyethyl starch (HES): dose-dependent and time-related. Br J Anaesth 82:510–515PubMedGoogle Scholar
  25. 25.
    Williams EL, Hildebrand KL, McCormick SA, Bedel MJ (1999) The effect of intravenous lactated Ringer’s solution versus 0.9% sodium chloride solution on serum osmolality in human volunteers. Anesth Analg 88:999–1003CrossRefPubMedGoogle Scholar
  26. 26.
    Zander R (2006) Flüssigkeitstherapie. 1. Aufl. Bibliomed, MelsungenGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  1. 1.Klinik für AnaesthesiologieKlinikum der Universität MünchenMünchen Deutschland

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