Zusammenfassung
Das Management der hämodynamischen Instabilität im Rahmen einer Sepsis bzw. eines septischen Schocks steht in der Notfallversorgung und auf der Intensivstation ganz im Vordergrund. Kreislaufinstabilität hat einen dramatischen Einfluss auf die Rate an Organkomplikationen und die Mortalität bei Sepsis. Nach der Leitlinie zur Therapie der Sepsis soll ein mittlerer arterieller Druck von 65 mm Hg nicht unterschritten werden. Kristalloide balancierte Flüssigkeit und Katecholamine sind die Eckpfeiler des therapeutischen Managements der septischen Kreislaufinstabilität. In diesem Beitrag sollen die wichtigsten Punkte – das Was, Wann und Wieviel – der Kreislauftherapie präsentiert und kritisch diskutiert werden.
Abstract
The management of hemodynamic instability in the context of sepsis or septic shock is at the forefront in emergency care as well as in the intensive care unit. Cardiovascular instability has a dramatic impact on the rate of organ complications and mortality from sepsis. According to the guideline for the treatment of sepsis, mean arterial pressure should not fall below 65 mm Hg. Crystalloid balanced fluid and catecholamines are the cornerstones of therapy management for septic cardiovascular instability. In this article, the most important points of what, when and how much regarding circulation therapy are presented and critically discussed.
This is a preview of subscription content, log in via an institution to check access.
Literatur
Asfar P, Meziani F, Hamel J‑F et al (2014) High versus low blood-pressure target in patients with septic shock. N Engl J Med 370:1583–1593
https://www.bfarm.de/SharedDocs/Risikoinformationen/Pharmakovigilanz/DE/RHB/2018/rhb-hes.html. Zugegriffen: 04.02.2020
Brown RM, Wang L, Coston TD et al (2019) Balanced crystalloids versus saline in sepsis. A secondary analysis of the SMART clinical trial. Am J Respir Crit Care Med 200:1487–1495
Caironi P, Tognoni G, Gattinoni L (2014) Albumin replacement in severe sepsis or septic shock. N Engl J Med 371:84–84
Finfer S, Bellomo R, Boyce N et al (2004) A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 350:2247–2256
Investigators A, Group ACT, Peake SL et al (2014) Goal-directed resuscitation for patients with early septic shock. N Engl J Med 371:1496–1506
Lamontagne F, Meade MO, Hebert PC et al (2016) Higher versus lower blood pressure targets for vasopressor therapy in shock: a multicentre pilot randomized controlled trial. Intensive Care Med 42:542–550
Leisman DE, Doerfler ME, Schneider SM et al (2018) Predictors, prevalence, and outcomes of early crystalloid responsiveness among initially hypotensive patients with sepsis and septic shock. Crit Care Med 46:189
Levy MM, Evans LE, Rhodes A (2018) The surviving sepsis campaign bundle: 2018 update. Crit Care Med 46:997–1000
Maheshwari K, Nathanson BH, Munson SH et al (2018) The relationship between ICU hypotension and in-hospital mortality and morbidity in septic patients. Intensive Care Med 44:857–867
Marik PE, Linde-Zwirble WT, Bittner EA et al (2017) Fluid administration in severe sepsis and septic shock, patterns and outcomes: an analysis of a large national database. Intensive Care Med. https://doi.org/10.1007/s00134-016-4675-y
Martensson J, Bihari S, Bannard-Smith J et al (2018) Small volume resuscitation with 20 % albumin in intensive care: physiological effects : the SWIPE randomised clinical trial. Intensive Care Med 44:1797–1806
Mouncey PR, Osborn TM, Power GS et al (2015) Trial of early, goal-directed resuscitation for septic shock. N Engl J Med 372:1301–1311
Myburgh J (2018) Patient-centered outcomes and resuscitation fluids. N Engl J Med 378:862–863
Myburgh JA, Higgins A, Jovanovska A et al (2008) A comparison of epinephrine and norepinephrine in critically ill patients. Intensive Care Med 34:2226–2234
Rhodes A, Evans LE, Alhazzani W et al (2017) Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med 45:486–552
Rivers E, Nguyen B, Havstad S et al (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377
Self WH, Semler MW, Wanderer JP et al (2018) Balanced crystalloids versus saline in noncritically ill adults. N Engl J Med 378:819–828
Semler MW, Kellum JA (2019) Balanced crystalloid solutions. Am J Respir Crit Care Med 199:952–960
Semler MW, Self WH, Wanderer JP et al (2018) Balanced crystalloids versus saline in critically ill adults. N Engl J Med 378:829–839
Singer M (2016) The new sepsis consensus definitions (Sepsis-3): the good, the not-so-bad, and the actually-quite-pretty. Intensive Care Med 42:2027–2029
Vincent J‑L, Nielsen ND, Shapiro NI et al (2018) Mean arterial pressure and mortality in patients with distributive shock: a retrospective analysis of the MIMIC-III database. Ann Intensive Care 8:107
Yealy DM, Kellum JA, Huang DT et al (2014) A randomized trial of protocol-based care for early septic shock. N Engl J Med 370:1683–1693
Zayed YZM, Aburahma AMY, Barbarawi MO et al (2018) Balanced crystalloids versus isotonic saline in critically ill patients: systematic review and meta-analysis. j intensive care 6:51
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Interessenkonflikt
M. Kochanek, A. Shimabukuro-Vornhagen, D.A. Eichenauer und B. Böll geben an, dass kein Interessenkonflikt besteht.
Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
Additional information
Redaktion
B. Salzberger, Regensburg
T. Welte, Hannover
Rights and permissions
About this article
Cite this article
Kochanek, M., Shimabukuro-Vornhagen, A., Eichenauer, D.A. et al. Kreislauftherapie bei Sepsis – wann, wie und wie viel?. Internist 61, 997–1001 (2020). https://doi.org/10.1007/s00108-020-00861-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00108-020-00861-6