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Katecholamine bei Traumapatienten

Catecholamines in trauma patients

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Zusammenfassung

Ziel

Die Hypotension im Rahmen des hämorrhagischen Schocks ist mit einer hohen Mortalität behaftet. Ziel dieses Beitrags ist es, den Stellenwert der Katecholamintherapie im traumatisch-hämorrhagischen Schock zu erläutern.

Ergebnisse

Der erste Schritt in der Therapie des hämorrhagischen Schocks ist die kristalloide und kolloidale Flüssigkeitsgabe. Bezüglich der zusätzlichen Verabreichung von Katecholaminen gibt es einige positive experimentelle Daten und Argumente, jedoch keine ausreichenden klinischen Daten, um klare Empfehlungen auszusprechen. Welches Katecholamin zu welchem Zeitpunkt im hämorrhagischen Schock verabreicht werden sollte, ist bis dato nicht definiert. Adrenalin und Noradrenalin zeigen im fortgeschrittenen hämorrhagischen Schock keine oder nur unzuverlässige Wirkungen, sodass Vasopressin im scheinbar ausweglosen, katecholaminrefraktären hämorrhagischen Schock als Therapieoption in Erwägung gezogen werden sollte.

Schlussfolgerung

Die Therapie im hämorrhagischen Schock ist Gegenstand intensiver Forschung. Es gibt bis dato keine Richtlinien bezüglich der Katecholamintherapie im hämorrhagischen Schock.

Abstract

Objective

Hemorrhage-induced hypotension is predictive of high mortality. The goal of this article is to describe the value of treatment with catecholamines in trauma-related hemorrhagic shock.

Results

The first step in the treatment of hemorrhagic shock is fluid loading with cristalloids and colloids. There are several reports concerning positive results in animal data and theoretical arguments that suggest additional administration of catecholamines, but there is still insufficient clinical evidence to validate this strategy. Both the type of vasopressor and the exact timing still need to be defined. Adrenaline and noradrenaline show unreliable or no effects in prolonged hemorrhagic shock, so that using vasopressin should be intended as a further therapy option.

Conclusion

The management of hemorrhagic shock is the subject of intensive research. No guidelines for use of vasopressor agents in hemorrhagic shock have been defined yet.

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Einhaltung der ethischen Richtlinien

Interessenkonflikt. A. Födinger und V. Wenzel geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich

    A. Födinger &  V. Wenzel M.Sc., FERC

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  1. A. Födinger
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  2. V. Wenzel M.Sc., FERC
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Corresponding author

Correspondence to V. Wenzel M.Sc., FERC.

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Födinger, A., Wenzel, V. Katecholamine bei Traumapatienten. Notfall Rettungsmed 16, 522–526 (2013). https://doi.org/10.1007/s10049-013-1712-z

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