Zusammenfassung
In der Versorgung von kritisch kranken Patienten spielt die differenzierte Therapie zur Behandlung von hämodynamischer Instabilität mit Schock im Sinne von akutem zirkulatorischem Versagen als häufiges Vollbild dieser Instabilität eine wesentliche Rolle. In Abhängigkeit der Schockform – distributiver Schock, kardiogener Schock, hypovolämer Schock oder obstruktiver Schock, wobei diese Komplexe überlappend vorliegen können – sind dabei Vorlast, Nachlast, Herzzeitvolumen und Kontraktilität in unterschiedlicher Art verändert. Die moderne intensivmedizinische Therapie nutzt zusätzlich zur klinischen Evaluation die Möglichkeiten des hämdoynamischen Monitorings und der bettseitigen echokardiographischen Bildgebung, um die zugrunde liegende Ursache und die daraus resultierenden Störungen zu behandeln. Die intravasale Volumentherapie unter Berücksichtigung von Volumenreagibilität und -notwendigkeit, die Therapie mit Vasopressoren unter Berücksichtigung von mikrozirkulatorischen Störungen und die positiv inotrope Therapie ggf. in Kombination mit Vasodilatation sind die Eckpfeiler der Behandlung des kritisch kranken Patienten. Vorlast, Nachlast, Herzzeitvolumen und Kontraktilität müssen dabei patienten- und situationsspezifisch evaluiert und therapiert werden.
Abstract
In caring for critically ill patients, a sophisticated approach to treating hemodynamic instability in acute circulatory failure is a major concern of modern critical care. Depending on the form of shock—distributive, cardiogenic, hypovolemic or obstructive, with the possibility of overlapping forms of shock—preload, afterload, cardiac output, and contractility are altered in various ways. Modern critical care uses hemodynamic monitoring and bedside echocardiography in addition to clinical evaluation to treat the underlying cause and sequelae of shock. Fluid therapy taking volume responsiveness and need for volume into account, vasopressor therapy taking microcirculatory derangement into account, and therapy using inotropes, sometimes in combination with vasodilators are the cornerstones of critical care treatment in this regard. Preload, afterload, cardiac output, and contractility must thereby be evaluated and treated in a patient- and situation-specific manner.
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Kersten, A. Kardiale Hämodynamik bei Schock. Med Klin Intensivmed Notfmed 111, 590–595 (2016). https://doi.org/10.1007/s00063-016-0168-6
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DOI: https://doi.org/10.1007/s00063-016-0168-6