Zusammenfassung
Störungen der Hämodynamik werden täglich auf Intensivstationen differenziert therapiert.
Die Frage, wann die Hämodynamik eines Patienten so instabil ist, dass der Einsatz
kardiovaskulär wirksamer Substanzen sinnvoll im Sinne einer Prognoseverbesserung des
Patienten ist, ist allerdings nicht leicht zu beantworten. In diesem Übersichtsartikel
sollen die wichtigsten klinischen und technischen Variablen dargestellt werden, die
hilfreich sind, um die Differenzialindikation zum Einsatz kardiovaskulär aktiver Substanzen
zu stellen. Ebenso werden häufig eingesetzte kardiovaskulär aktive Substanzen charakterisiert
und deren Wirkspektrum kritisch dargestellt.
Literatur
- 1
Hadian M, Pinsky M R.
Evidence-based review of the use of the pulmonary artery catheter: impact data and
complications.
Crit Care.
2006;
10 (Suppl 3)
S8
- 2
Tavernier B, Makhotine O, Lebuffe G. et al .
Systolic pressure variation as a guide to fluid therapy in patients with sepsis-induced
hypotension.
Anesthesiology.
1998;
89
1313-1321
- 3
Rivers E, Nguyen B, Havstad S. et al .
Early goal-directed therapy in the treatment of severe sepsis and septic shock.
N Engl J Med.
2001;
345
1368-1377
- 4
Dellinger R P, Carlet J M, Masur H. et al .
Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock.
Crit Care Med.
2004;
32
858-873,
- 5
Vignon P.
Hemodynamic assessment of critically ill patients using echocardiography Doppler.
Curr Opin Crit Care.
2005;
11
227-234
- 6
Rauch H, Motsch J, Bottiger B W.
Newer approaches to the pharmacological management of heart failure.
Curr Opin Anaesthesiol.
2006;
19
75-81
- 7
Ince C, Sinaasappel M.
Microcirculatory oxygenation and shunting in sepsis and shock.
Crit Care Med.
1999;
27
1369-1377
- 8
Dellinger R P, Levy M M, Carlet J M. et al .
Surviving Sepsis Campaign: international guidelines for management of severe sepsis
and septic shock: 2008.
Crit Care Med.
2008;
36
296-327
- 9
Hollenberg S M, Ahrens T S, Annane D. et al .
Practice parameters for hemodynamic support of sepsis in adult patients: 2004 update.
Crit Care Med.
2004;
32
1928-1948
- 10
Beale R J, Hollenberg S M, Vincent J L. et al .
Vasopressor and inotropic support in septic shock: an evidence-based review.
Crit Care Med.
2004;
32
S455-S465
- 11
Vincent J L, Piagnerelli M.
Transfusion in the intensive care unit.
Crit Care Med.
2006;
34
S96-S101
- 12
Theilmeier G, Booke M.
Norepinephrine in septic patients – friend or foe?.
J Clin Anesth.
2003;
15
154-158
- 13
Reinelt H, Radermacher P, Fischer G. et al .
Effects of a dobutamine-induced increase in splanchnic blood flow on hepatic metabolic
activity in patients with septic shock.
Anesthesiology.
1997;
86
818-824
- 14
Bellomo R, Chapman M, Finfer S. et al .
Low-dose dopamine in patients with early renal dysfunction: a placebo-controlled randomised
trial. Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials
Group.
Lancet.
2000;
356
2139-2143
- 15
Kellum J A, Decker M.
Use of dopamine in acute renal failure: a meta-analysis.
Crit Care Med.
2001;
29
1526-1531
- 16
Debaveye Y A, Van den Berghe G H.
Is there still a place for dopamine in the modern intensive care unit?.
Anesth Analg.
2004;
98
461-468
- 17
Van den Berghe G, Zegher de F.
Anterior pituitary function during critical illness and dopamine treatment.
Crit Care Med.
1996;
24
1580-1590
- 18
Reinhart K, Brunkhorst F M, Bone H G. et al .
Diagnosis and therapy of sepsis Guidelines of the German Sepsis Society Inc. and the
German Interdisciplinary Society for Intensive and Emergency Medicine.
Internist.
2006;
- 19
Annane D, Vignon P, Renault A. et al .
Norepinephrine plus dobutamine versus epinephrine alone for management of septic shock:
a randomised trial.
Lancet.
2007;
370
676-684
- 20
Renton M C, Snowden C P.
Dopexamine and its role in the protection of hepatosplanchnic and renal perfusion
in high-risk surgical and critically ill patients.
Br J Anaesth.
2005;
94
459-467
- 21
Lehtonen L A, Antila S, Pentikainen P J.
Pharmacokinetics and pharmacodynamics of intravenous inotropic agents.
Clin Pharmacokinet.
2004;
43
187-203
- 22
Petersen J W, Felker G M.
Inotropes in the management of acute heart failure.
Crit Care Med.
2008;
36
S106-S111
- 23
Sharma M, Teerlink J R.
A rational approach for the treatment of acute heart failure: current strategies and
future options.
Curr Opin Cardiol.
2004;
19
254-263
- 24
Toller W G, Stranz C.
Levosimendan, a new inotropic and vasodilator agent.
Anesthesiology.
2006;
104
556-569
- 25
Moiseyev V S, Poder P, Andrejevs N. et al .
Safety and efficacy of a novel calcium sensitizer, levosimendan, in patients with
left ventricular failure due to an acute myocardial infarction. A randomized, placebo-controlled,
double-blind study (RUSSLAN).
Eur Heart J.
2002;
23
1422-1432
- 26
Follath F, Cleland J G, Just H. et al .
Efficacy and safety of intravenous levosimendan compared with dobutamine in severe
low-output heart failure (the LIDO study): a randomised double-blind trial.
Lancet.
2002;
360
196-202
- 27
Morelli A, De Castro S, Teboul J L. et al .
Effects of levosimendan on systemic and regional hemodynamics in septic myocardial
depression.
Intensive Care Med.
2005;
31
638-644
- 28
Pinto B B, Rehberg S, Ertmer C. et al .
Role of levosimendan in sepsis and septic shock.
Curr Opin Anaesthesiol.
2008;
21
168-177
- 29
Holmes C L, Patel B M, Russell J A. et al .
Physiology of vasopressin relevant to management of septic shock.
Chest.
2001;
120
989-1002
- 30
Russell J A, Walley K R, Singer J. et al .
Vasopressin versus norepinephrine infusion in patients with septic shock.
N Engl J Med.
2008;
358
877-887
- 31
Wenzel V, Krismer A C, Arntz H R. et al .
A comparison of vasopressin and epinephrine for out-of-hospital cardiopulmonary resuscitation.
N Engl J Med.
2004;
350
105-113
- 32
Martin C, Papazian L, Perrin G. et al .
Norepinephrine or dopamine for the treatment of hyperdynamic septic shock?.
Chest.
1993;
103
1826-1831
- 33
Ruokonen E, Parviainen I, Uusaro A.
Treatment of impaired perfusion in septic shock.
Ann Med.
2002;
34
590-597
- 34
Martin C, Viviand X, Leone M. et al .
Effect of norepinephrine on the outcome of septic shock.
Crit Care Med.
2000;
28
2758-2765
- 35
Sakr Y, Reinhart K, Vincent J L. et al .
Does dopamine administration in shock influence outcome? Results of the Sepsis Occurrence
in Acutely Ill Patients (SOAP) Study.
Crit Care Med.
2006;
34
589-597
- 36
Tavares M, Rezlan E, Vostroknoutova I. et al .
New pharmacologic therapies for acute heart failure.
Crit Care Med.
2008;
36
S112-S120
Prof. Dr. med. Martin Westphal
Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum
Münster
Albert-Schweitzer-Str. 33
48149 Münster
Email: Martin.Westphal@gmx.net
