Zusammenfassung
Vasoaktive Medikamente und Inotropika sind wichtige Bausteine im hämodynamischen Management des kardiogenen Schocks. In diesem Beitrag wird der Einsatz der unterschiedlichen vasoaktiven und ionotropen Medikamente beim kardiogenen Schock dargestellt. Das hämodynamische Management beim kardiogenen Schock erfolgt nach initialer moderater Volumengabe durch Dobutamin zur Steigerung der Inotropie. Wenn keine ausreichenden Perfusionsdrücke erzielt werden, erfolgt die Gabe von Noradrenalin. Sollte weiterhin keine suffiziente Steigerung der Herzleistung erreicht werden, kann die Gabe von Levosimendan oder Phosphodiesterase (PDE)-Hemmern erfolgen. Levosimendan ist bei Patienten im kardiogenem Schock den PDE-Hemmern vorzuziehen. Ziel des hämodynamischen Managements bei kardiogenem Schock ist der passagere Einsatz von Inotropika und Vasopressoren in der geringsten notwendigen Dosis und nur so lange wie notwendig. Es muss täglich die Frage gestellt werden, ob die Dosis reduziert werden kann bzw. ob der Einsatz eines extrakorporalen Kreislaufunterstützungssystems erwogen werden sollte. Es gibt bisher keine Mortalitätsdaten, die den Nutzen des hämodynamischen Monitorings anhand von Zielkriterien belegen. Der Vorteil ergibt sich aber aus dem sparsameren Einsatz von Inotropika und Vasopressoren durch gewisse Zielkriterien.
Abstract
Vasoactive drugs and inotropic agents are important for the hemodynamic management of cardiogenic shock. In this article the use of different vasoactive and ionotropic drugs in cardiogenic shock is presented. Hemodynamic management during cardiogenic shock occurs after initial moderate volume delivery by dobutamine to increase inotropism. If adequate perfusion pressures are not achieved norepinephrine is administered. If a sufficient increase in cardiac performance can still not be achieved by the treatment, administration of levosimendan or phosphodiesterase (PDE) inhibitors may be necessary. Levosimendan is superior to PDE inhibitors for patients in cardiogenic shock. The aim of hemodynamic management in cardiogenic shock is to allow the transient use of inotropics and vasopressors in the lowest necessary dose and only as long as necessary. The daily question is whether the dose can be reduced or in the case of deterioration whether the use of an extracorporeal circulatory support system should be considered. There are currently no available data on mortality that demonstrate the benefit of hemodynamic monitoring using target criteria. The advantage, however, results from the economic use of inotropics and vasopressors by certain target criteria.
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H. Lemm, S. Dietz, M. Janusch und M. Buerke geben an, dass kein Interessenkonflikt besteht.
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Lemm, H., Dietz, S., Janusch, M. et al. Einsatz von Vasopressoren und Inotropika im kardiogenen Schock. Herz 42, 3–10 (2017). https://doi.org/10.1007/s00059-016-4525-2
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DOI: https://doi.org/10.1007/s00059-016-4525-2