Skip to main content
SpringerLink
Log in

Verbesserung der Gewebeoxygenierung. Intensivtherapie bei Sepsis

  • Chapter
Intensivtherapie bei Sepsis und Multiorganversagen

  • 15 Accesses

Zusammenfassung

Gewebehypoxie gilt als wichtiger Kofaktor in der Pathogenese des Multiorganversagens [20]. Sie ist eine Folge der kardiozirkulatorischen Veränderungen, zu denen es durch die überschießende Mediatorenaktivierung kommt. Gleichzeitig ist davon auszugehen, daß Gewebehypoxie eine weitere aktivierende Wirkung auf die verschiedenen Mediator- und Kaskadensysteme hat. Einer adäquaten Gewebeoxygenierung kommt deshalb in der symptomatischen Therapie der Sepsis und des septischen Schocks eine zentrale Rolle zu, hierzu geeignete Strategien stehen deshalb im Mittelpunkt der intensivmedizinischen Maßnahmen. Folgende in Tabelle 9.1 aufgeführten Faktoren können zu einer unzureichenden Gewebeoxygenierung beim septischen Schock führen.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 54.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. Cain SM, Curtis SE (1991) Systemic and regional oxygen uptake and delivery and lactate flux in endotoxic dogs infused with dopexamine. Crit Care Med 12: 1552–1560

    Article  Google Scholar 

  2. Dahn MS, Lange MP, Lobdell IL et al. (1989) Hepatic blood flow and splanchnic oxygen consumption measurements in clinical sepsis. Surgery 107: 295–301

    Google Scholar 

  3. Desjars P, Pinaud M, Potel G et al. (1987) A reappraisal of norepinephrine in human septic shock. Crit Care Med 15: 134–137

    Article  PubMed  CAS  Google Scholar 

  4. Dhainaut JF, Edwards JD, Grootendorst AF, Nightingale P, Pinky MR, Reinhart K, Shoemaker WC, Vincent JL (1990) Practical aspects of oxygen transport: conclusions and recommendations of the Round Table Conference. Int Care Med 16: 179–180

    Article  Google Scholar 

  5. Fiddian-Green RG, Baker GS (1987) Predictive value of the stomach wall pH for complications after cardiac operations: Comparison with other monitoring. Crit Care Med 15: 153

    Google Scholar 

  6. Giraud GD, MacCannell K (1984) Decreased nutrient blood flow during dopamine-and epinephrine-induced intestinal vasodilatation. J Pharmacol Exp Ther 230: 214–220

    PubMed  CAS  Google Scholar 

  7. Gutierrez G, Polizas F, Doglio G et al. (1992) Gastric intramucosal pH as a therapeutic index of tissue oxygenation in critically ill patients. Lancet 339: 195–199

    Article  PubMed  CAS  Google Scholar 

  8. Gutierrez GH, Bismar H, Dantzker DR, Silva N (1992) Comparison of gastric intramucosal pH with measures of oxygen transport and consumption in critically ill patients. Crit Care Med 20: 451–457

    Article  PubMed  CAS  Google Scholar 

  9. Hannemann L, Reinhart K, Meier-Hellmann A (in Vorbereitung) Short-term prostacyclin in hyperdynamic septic shock patients

    Google Scholar 

  10. Harrison PM, Wendon JA, Gimson AES et al. (1991) Improvement by acetylcysteine of hemodynamics and oxygen transport in fulminant hepatic failure. N Engl J Med 324: 1853–1857

    Article  Google Scholar 

  11. Leier CV (1988) Regional blood flow responses to vasodilators and inotropes in congestive heart failure. Am J Cardiol 62: 86E - 93E

    Article  PubMed  CAS  Google Scholar 

  12. Meier-Hellmann A, Hannemann L, Specht M, Schaffartzik W, Spies C, Reinhart K (im Druck) The relationship between mixed venous and hepatic venous 02 saturation in patients with septic shock. Adv Exp Med Biol

    Google Scholar 

  13. Reinhart K (1988) Zum Monitoring des Sauerstofftransportsystems. Anaesthesist 37: 1–9

    PubMed  CAS  Google Scholar 

  14. Reinhart K, Hannemann L, Meier-Hellmann A (1991) Sauerstofftransport and Gewebeoxygenierung beim kritisch Kranken–Stellenwert von Volumen and vasoaktiven Substanzen. Klin Wochenschr 60 [Suppl XXVI]: 112–118

    Google Scholar 

  15. Reinhart K, Hannemann L, Kuss B (1990) Optimal levels of 02 delivery in the critically ill. Int Care Med 16: S149–154

    Article  Google Scholar 

  16. Reynolds HN, Haupt MT, Baharozian MC et al. (1988) Impact of critical care physician staffing on patients with septic shock in a university hospital medical intensive care unit. JAMA 260: 3446–3450

    Article  PubMed  CAS  Google Scholar 

  17. Schaer GL, Mitchell P, Fink MP, Parrillo JE et al. (1985) Norepinephrine alone versus norepinephrine plus low-dose depamine: Enhanced renal blood flow with combination vasopressor therapy. Crit Care Med 13: 492–496

    Google Scholar 

  18. Shoemaker WC, Appel PL, Kram HB, Waxman K, Lee TS (1988) Prospective trial of supranormal values of survivors as therapeutic goals in high risk surgical patients. Chest 94: 1176–1186

    Article  PubMed  CAS  Google Scholar 

  19. Shoemaker WC, Appel PL, Kram HB (1986) Hemodynamic and oxygen transport effects of dobutamine in critical ill general surgical patients. Crit Care Med 14: 1032

    Article  PubMed  CAS  Google Scholar 

  20. Sibbald WJ, Bersten A, Rutledge FS (1989) The role of tissue hypoxia in multiple organ failure. In: Reinhart K, Eyrich K (eds) Clinical aspects of oxygen transport and tissue oxygenation. Springer, Berlin Heidelberg New York Tokyo, pp 102–114

    Google Scholar 

  21. Tuchschmidt J, Fried J, Astiz M, Rackow E (1992) Elevation of cardiac output and oxygen delivery improves outcome in septic shock. Chest 102: 216–220

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. K. Reinhart
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Medizinische Klinik I, Städtisches Krankenhaus Hildesheim Lehrkrankenhaus, Medizinischen Hochschule Hannover, Weinberg 1, W-3200, Hildesheim, Deutschland

    Hans-Peter Schuster

Rights and permissions

Reprints and permissions

Copyright information

© 1993 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Reinhart, K. (1993). Verbesserung der Gewebeoxygenierung. Intensivtherapie bei Sepsis. In: Schuster, HP. (eds) Intensivtherapie bei Sepsis und Multiorganversagen. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-07960-7_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-07960-7_9

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-07961-4

  • Online ISBN: 978-3-662-07960-7

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation