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Pulmonalarterienkatheter

Einsatz in Anästhesie und Intensivmedizin

Pulmonary artery catheter in anaesthesiology and intensive care medicine

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Zusammenfassung

Der Einsatz des Pulmonalarterienkatheters (PAK) zur erweiterten hämodynamischen Überwachung wird in der konservativen und operativen Medizin in den letzten Jahren zunehmend kritisch hinterfragt. Seit Mitte der 90er-Jahre zeigte sich, dass der Einsatz des Pulmonalarterienkatheters die Letalität und Morbidität schwerstkranker Patienten nicht positiv beeinflusst. In einigen Untersuchungen fand sich sogar eine höhere Letalität bei Patienten, die mit dem PAK überwacht wurden. Daher wurden in den letzten Jahren randomisierte Untersuchungen mit adäquater Fallzahl bei Patienten mit ARDS, Herzinsuffizienz, Multiorganversagen und Hochrisikochirurgie durchgeführt. In der Mehrzahl der aktuellen Untersuchungen zeigte sich kein positiver Einfluss des Monitorings mit dem PAK auf das Überleben und die Komplikationsrate. Der vorliegende Beitrag gibt eine Übersicht über Messparameter der aktuellen PAK-Generation, mögliche Alternativen und die aktuelle Studienlage zum Einsatz des PAK in der Anästhesie und Intensivmedizin

Abstract

The indication for the use of the pulmonary artery catheter (PAC) in high-risk patients is still a matter of discussion. Observational studies suggested that the use of the PAC did not result in decreased mortality but may even lead to increased mortality and morbidity. Therefore, a number of randomized controlled trials have been performed throughout recent years in patients suffering from sepsis/ARDS, congestive heart failure, multi-organ failure and those undergoing high-risk non-cardiac surgery. The majority of recent randomized studies failed to demonstrate any benefit of the PAC with respect to mortality and morbidity. However, the use of the PAC was also regularly not associated with an increase in morbidity and/or mortality. This review gives an overview of measurement parameters obtained by the current generation of PACs, alternatives to the PAC and recent studies on the use of the PAC in clinical practice.

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Interessenkonflikt

Der korrespondierende Autor weist auf eine Verbindung mit folgender Firma/Firmen hin: Der korrespondierende Autor ist Mitglied des Medical Advisory Board der Pulsion Medical Systems AG und hat von der Fa. Pulsion Honorare für Vorträge erhalten.

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Authors and Affiliations

  1. Division of Intensive Care Medicine, University Medical Center Utrecht

    E. E. C. de Waal

  2. Klinik für Anästhesiologie, Universitätsklinikum der RWTH Aachen

    L. de Rossi

  3. Division of Perioperative and Emergency Medicine, Department of Anaesthesiology, University Medical Center Utrecht, P.O. Box 85500, GA 3508, Utrecht, The Netherlands

    E. E. C. de Waal &  W. Buhre

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  1. E. E. C. de Waal
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  2. L. de Rossi
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  3. W. Buhre
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Correspondence to W. Buhre.

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de Waal, E.E.C., de Rossi, L. & Buhre, W. Pulmonalarterienkatheter. Anaesthesist 55, 713–730 (2006). https://doi.org/10.1007/s00101-006-1037-0

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  • DOI: https://doi.org/10.1007/s00101-006-1037-0

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