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Beurteilung der Mikrozirkulation beim kritisch kranken Patienten

Assessment of microcirculation in critically ill patients

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Zusammenfassung

Die Mikrozirkulation ist für eine adäquate Sauerstoff- und Nährstoffversorgung der Organe wesentlich. Ist sie gestört, droht temporärer oder auch irreversibler Funktionsverlust. Daher ist die frühzeitige Erfassung und Behandlung von Mikrozirkulationsstörungen bei kritisch kranken Patienten essenziell. Urinproduktion und Serumlaktat sind Surrogatparameter der Mikrozirkulation. Mit der Sidestream-darkfield-Mikroskopie kann sie jedoch direkt visualisiert werden, was sich allerdings in der klinischen Routine noch nicht etabliert hat. In klinischen Studien zum kardiogenen Schock konnte der Nutzen einer Mikrozirkulationsmessung bei frühzeitiger Diagnosestellung und Therapiesteuerung mit Vasopressoren, Nitraten und mechanischen Kreislaufunterstützungssystemen bereits belegt werden. Dies muss jedoch noch in weiteren Studien evaluiert werden, bevor eine generelle Empfehlung für ihren Einsatz in der klinischen Routine abgegeben werden kann.

Abstract

Adequate organ supply of oxygen and of nutrients depends on microcirculation. Impaired microcirculation may result in temporary or irreversible loss of function. Therefore, critically ill patients require early diagnosis and therapy of microcirculatory disorders. Besides surrogate parameters of microcirculation like urine production or serum lactate levels, direct visualization became possible with sidestream darkfield intravital microscopy. This technique has been evaluated in clinical studies focusing on early diagnosis and therapy in cardiogenic shock like vasopressors, nitrates, or circulatory assist devices. Further studies evaluating measurements of microcirculation are necessary before a general recommendation for its routine use can be made.

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Authors and Affiliations

  1. Medizinische Fakultät, Klinik für Kardiologie, Pulmonologie und Angiologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland

    C. Jung & M. Kelm

  2. HELIOS Dr. Horst Schmidt Kliniken Wiesbaden, Ludwig-Erhard-Straße 100, 65199, Wiesbaden, Deutschland

    M. Ferrari

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  1. C. Jung
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  2. M. Kelm
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  3. M. Ferrari
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Correspondence to C. Jung.

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Interessenkonflikt

C. Jung, M. Kelm und M. Ferrari geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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L. Engelmann, Leipzig

U. Janssens, Eschweiler

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Jung, C., Kelm, M. & Ferrari, M. Beurteilung der Mikrozirkulation beim kritisch kranken Patienten. Med Klin Intensivmed Notfmed 111, 605–609 (2016). https://doi.org/10.1007/s00063-016-0169-5

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  • DOI: https://doi.org/10.1007/s00063-016-0169-5

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