Zusammenfassung
Bei allen Schockformen hängt die Prognose im Wesentlichen von einer unverzüglichen und effizienten Therapie ab. Deshalb sind die schnelle Diagnosestellung und das Erkennen der zu Grunde liegenden Ursache von elementarer Bedeutung für den weiteren Verlauf der Erkrankung. Mit Ausnahme des kardiogenen Schocks ist bei allen Schockformen eine frühzeitige und ausreichende Volumentherapie essenziell. Für den septischen Schock konnte gezeigt werden, dass eine an der zentralvenösen Sättigung orientierte Schocktherapie zu einer Mortalitätssenkung führen kann. Für die invasiveren, im Rahmen der Intensivtherapie angewandten Monitoringverfahren sind entsprechende Algorithmen in Entwicklung; ihr Wirksamkeitsnachweis steht allerdings noch aus. Neue Entwicklungen betreffen die adjunktive Sepsistherapie und den Einsatz von Vasopressin, der allerdings noch nicht abschließend beurteilt werden kann.
Abstract
Since the prognosis for all forms of shock essentially depends on immediate and effective therapy, early diagnosis and determination of the underlying cause are of central importance to the disease course. Except for cardiogenic shock, all forms of shock require early and adequate fluid substitution. It has previously been shown that septic shock treatment guided by central venous oxygen saturation may lead to a reduction in mortality in patients with septic shock. Similar therapeutic strategies are currently being developed for the more invasive monitoring procedures used in intensive care, but their effectiveness has to yet to be proven. Novel therapeutic approaches for the treatment of septic shock include improved adjunctive sepsis therapy and the use of vasopressin. However, the effectiveness of the latter treatment option cannot yet be conclusively assessed.
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Kluge, S., Kreymann, G. Zielgerichtete Kreislauftherapie. Internist 47, 389–401 (2006). https://doi.org/10.1007/s00108-006-1587-x
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DOI: https://doi.org/10.1007/s00108-006-1587-x