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Indozyaningrünplasmaverschwinderate

Abschätzung abdomineller Perfusionsstörungen

Indocyanine green plasma disappearance rate

Estimation of abdominal perfusion disturbances

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Zusammenfassung

Intraabdominelle Druck- (IAP-)Erhöhung und abdominelles Kompartmentsyndrom (ACS) sind Krankheitsbilder, die gerade beim kritisch kranken Patienten sowohl in Inzidenz als auch hinsichtlich prognostischer Bedeutung oftmals unterschätzt werden. Als international akzeptierte Standardmethode zur Erfassung des IAP gilt die intravesikale Druckmessung. Zur Beurteilung der Perfusion im Hepatosplanchnikusstromgebiet steht mit der transkutan messbaren Indozyaningrünplasmaverschwinderate („indocyanine green plasma disappearance rate“, ICG-PDR) eine klinisch attraktive Methode zur Verfügung. In dieser Untersuchung wurde die tatsächliche Beeinträchtigung der Splanchnikusperfusion durch erhöhten IAP bei kritisch kranken Patienten mit abdominell fokusierter Sepsis oder postoperativem „systemic inflammatory response syndrome“ (SIRS) betrachtet. Es konnte gezeigt werden, dass die Reduktion der ICG-PDR als Maß für die Splanchnikusdurchblutung zuverlässig mit dem Anstieg des IAP korreliert. Zudem fand sich, dass eine relevante Reduktion der Hepatosplanchnikusdurchblutung bereits bei deutlich niedrigeren IAP-Werten auftritt, als bisher allgemein angenommen.

Abstract

Increased intraabdominal pressure (IAP) and abdominal compartment syndrome (ACS) are diseases which are often underestimated with respect to incidence and prognosis especially in critically ill patients. The clinical gold standard for the determination of IAP is the urinary bladder measurement technique. For assessment of hepatosplanchnic perfusion the indocyanine green plasma disappearance rate (ICG-PDR) has recently become a clinically attractive method. In this investigation a decrease in splanchnic perfusion caused by increased IAP was observed in critically ill patients with abdominal focused sepsis or postoperative systemic inflammatory response syndrome (SIRS). It was found that the reduction of ICG-PDR as a measure of splanchnic blood flow correlated with the increase of IAP, i.e. increased IAP is associated with lower ICG-PDR. Furthermore, the data suggest that a relevant decrease of splanchnic blood flow may appear even during lower IAP than previously assumed.

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Interessenkonflikt

Der Autor Prof. Dr. Sakka ist Mitglied des Medical Advisory Board der Fa. Pulsion Medical Systems AG, München, und erhielt Honorare für Vorträge von dieser Firma und MSD Sharp Dohme, München.

Ebenso erhielt der Autor A. Seibel Referentenhonorare von der Fa. Pulsion Medical Systems AG, München.

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Authors and Affiliations

  1. Abteilung für Anästhesiologie, Intensiv- und Notfallmedizin, Diakonie Klinikum, Jung-Stilling-Krankenhaus, Siegen, Deutschland

    A. Seibel

  2. Klinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Witten/Herdecke mit Sitz in Köln, Kliniken der Stadt Köln gGmbH, Krankenhaus Merheim, Ostmerheimerstr. 200, 51109, Köln, Deutschland

    S.G. Sakka DEAA, EDIC

Authors
  1. A. Seibel
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  2. S.G. Sakka DEAA, EDIC
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Correspondence to S.G. Sakka DEAA, EDIC.

Additional information

Teile dieses Beitrags wurden auf dem World Congress of Abdominal Compartment Syndrome (WCACS) 2007 in Antwerpen referiert.

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Seibel, A., Sakka, S. Indozyaningrünplasmaverschwinderate. Anaesthesist 59, 1091–1098 (2010). https://doi.org/10.1007/s00101-010-1754-2

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  • DOI: https://doi.org/10.1007/s00101-010-1754-2

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