Kreislauf- und Volumenmanagement bei Sepsis – Was ist zu beachten?

Die führenden Ziele der Therapie mittels Flüssigkeitssubstitution und vasoaktiven Substanzen im septischen Schock sollten die Wiederherstellung einer effektiven Gewebsperfusion und die Normalisierung des zellulären Metabolismus sein. Hierbei müssen sowohl die globale, als auch die regionale Hämodynamik berücksichtigt werden. Ohne eine frühzeitige und adäquate Volumentherapie ist eine Behandlung mit Katecholaminen und Vasopressoren allerdings grob unvollständig und wenig erfolgversprechend.

Die therapeutischen Endpunkte sind jedoch nach wie vor nicht exakt definiert und Gegenstand aktueller und zukünftiger Studien. Dynamische, flussorientierte Monitoring- und Therapieansätze scheinen gegenüber statischen, druckorientierten Vorgehensweisen von Vorteil zu sein.

The top priority objective of therapy for septic shock with fluid replacement and vasoactive substances should always be to restore an effective tissue perfusion and to normalize the cellular metabolism. In these cases, special attention must be paid not only to the global but also the regional hemodynamics. In the absence of an early and adequate volume therapy, however, treatment with catecholamines and vasopressors is crassly incomplete and has little hope of success.

The therapeutic endpoints, however, are still not precisely defined and remain a topic for current and future studies. Dynamic, flow-oriented monitoring and therapeutic strategies seem to have advantages over static, pressure-oriented procedures.

Key words

Sepsis - fluid replacement - volume therapy - hemodynamic stabilization - vasoactive substances

• Literatur

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