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Katecholamine: Pro und Kontra

Catecholamines: pro and contra

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Zusammenfassung

Hintergrund

Katecholamine als vasopressorisch und inotrop wirksame Substanzen gehören zu den am häufigsten in der Intensivmedizin eingesetzten Medikamenten. Ziel dieser Übersicht ist es, neben den physiologischen Grundlagen einer Katecholamintherapie besonders auch die Risiken darzustellen, die sich aus einer unkritischen und übermäßigen Gabe dieser Substanzen ergeben können.

Ungünstige Wirkungen

Im Mittelpunkt steht dabei eine durch eine adrenerge Überstimulation ausgelöste Schädigung des Herzens. Es gibt deutliche Hinweise dafür, dass bei schwerer Herzinsuffizienz, bei Myokardischämien sowie im kardiogenen und septischen Schock speziell der Einsatz von Katecholaminen mit stärkerer β-adrenerger Wirkung (Adrenalin, Dobutamin, Dopamin) ungünstige Wirkungen haben kann. Als einfacher Risikomarker für eine kardiale Schädigung ist dabei eine Tachykardie anzusehen.

Anwendung

Eine individuell an Perfusionsparametern (z. B. Urinausscheidung, Laktat) ausgerichtete Therapie mit Vasopressoren, wie Noradrenalin, erscheint dagegen bei den verschiedenen Formen des Schocks sowie bei hämodynamischer Instabilität im Rahmen einer tiefen Analgosedierung als gerechtfertigt. Im Sinne einer kardioprotektiven Therapie sollte der Einsatz von Katecholaminen jedoch grundsätzlich immer wieder hinterfragt und auf ein als notwendig erachtetes Minimum titriert werden.

Abstract

Background

Catecholamines with vasopressor and inotropic effects are commonly used in intensive care medicine. The aim of this review is to explain some of the physiologic actions on which a catecholamine therapy is based, but also to elucidate the risks which are associated with an uncritical and excessive use of these drugs.

Side effects

Emphasis is placed on the myocardial damage triggered by adrenergic overstimulation. There is considerable evidence that in conditions of severe heart failure, myocardial ischemia as well as cardiogenic and septic shock especially the use of catecholamines with predominant β-adrenergic effects (epinephrine, dobutamine, dopamine) can have a negative clinical impact. A simple cardiac risk marker might be a tachycardia.

Administration

Vasopressor therapy with norepinephrine, based on individually applied perfusion parameters (e.g., urine output, lactate), however, seems justified in many conditions of shock and hemodynamic instability during deep analgosedation. In terms of a cardioprotective therapy, the administration of catecholamines, however, should always be reevaluated and titrated to the minimum deemed necessary.

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  1. Internistische Intensivstation, Department für Innere Medizin, Universitätsklinikum Tübingen, Otfried-Müller Str. 10, 72076, Tübingen, Deutschland

    R. Riessen & M. Haap

  2. Interdisziplinäre Notaufnahme, Marienhospital Stuttgart, Stuttgart, Deutschland

    O. Tschritter

  3. Innere Medizin, St.-Antonius-Hospital, Eschweiler, Deutschland

    U. Janssens

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Riessen, R., Tschritter, O., Janssens, U. et al. Katecholamine: Pro und Kontra. Med Klin Intensivmed Notfmed 111, 37–46 (2016). https://doi.org/10.1007/s00063-015-0011-5

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