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S3-Leitlinie zur intensivmedizinischen Versorgung herzchirurgischer Patienten

Hämodynamisches Monitoring und Herz-Kreislauf-System

S3 Guidelines for intensive care of cardiac surgery patients

Hemodynamic monitoring and cardiocirculatory system

  • Evidenzbasierte Medizin
  • Published:
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Das hämodynamische Monitoring und die Differenzialtherapie mittels adäquater Volumensubstitution sowie positiv-inotroper und vasoaktiver Substanzen sind die Grundpfeiler der postoperativen intensivmedizinischen Behandlung von kardiochirurgischen Patienten. Ziel der S3-Leitlinie ist es, die Empfehlungen zum Monitoring und zur Therapie evidenzbasiert zu prüfen sowie Zielkriterien hierfür festzulegen. Die Bewertung erhobener Messparameter im Zusammenhang mit der klinischen Gesamtsituation des Patienten erlaubt die Entwicklung eines weiterführenden Therapiekonzepts und die Festlegung von Zielkriterien zur Kontrolle des Behandlungserfolgs.

Bislang existieren Leitlinien und Empfehlungen lediglich für Teilbereiche der kardiochirurgischen Intensivmedizin. So bestehen Leitlinien für den Einsatz des Pulmonalarterienkatheters und der transösophagealen Echokardiographie für diesen speziellen Bereich der postoperativen Patientenversorgung.

Die Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie (DGTHG) und die Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) haben sich daher zum Ziel gesetzt, einen nationalen Ansatz zur Sicherung und Verbesserung der Qualität der postoperativen kardiochirurgischen Intensivmedizin mit der vorliegenden evidenzbasierten S3-Konsensusleitlinie zu schaffen.

Ziel dieser Leitlinie ist eine Bewertung der verfügbaren Monitoringverfahren im Hinblick auf Indikationen, Vorgehen, Aussagen, Limitationen, Kontraindikationen und Risiken; weiterhin die Differenzialtherapie mit Volumenersatzlösungen vs. positiv inotropen und vasoaktiven Substanzen, die differenzierte Katecholamintherapie einschließlich der Inodilatoren und Kalziumsensitizer sowie die Einsatzkriterien der intraaortalen Ballonpumpe.

Die Leitlinie ist in einem standardisierten Prozess nach Vorgaben der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) erstellt worden. Die Verabschiedung der Kernaussagen der Leitlinie erfolgte in zwei Konsensusverfahren unter Moderation der AWMF.

Abstract

Hemodynamic monitoring and adequate volume therapy, as well as treatment with positive inotropic drugs and vasopressors are the basic principles of postoperative intensive care treatment of patients after cardiothoracic surgery. The goal of these S3 guidelines is to evaluate the recommendations with respect to evidence-based medicine and to define therapy goals for monitoring and therapy. In context with the clinical situation the evaluation of the different hemodynamic parameters allows the development of a therapeutic concept and the definition of target criteria to evaluate the effect of treatment.

Up to now there have only been guidelines for subareas of postoperative treatment of cardiothoracic surgical patients, such as the use of pulmonary artery catheters or transesophageal echocardiography.

The German Society for Thoracic and Cardiovascular Surgery and the German Society for Anesthesiology and Intensive Care Medicine made an approach to ensure and improve the quality of postoperative intensive care medicine after cardiothoracic surgery by the development of S3 consensus-based treatment guidelines.

The goal of these guidelines is to assess the available monitoring methods with respect to indications, procedures, predication, limits, contraindications and risks for use. The differentiated therapy of volume replacement, positive inotropic support and vasoactive drugs, the therapy with vasodilatators, inodilatators and calcium sensitizers and the use of intra-aortic balloon pumps will also be addressed.

These guidelines have been developed following the recommendations for the development of guidelines by the Association of the Scientific Medical Societies in Germany (AWMF). The presented key messages of the guidelines were approved after two consensus meetings under the moderation of the AWMF.

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Interessenkonflikt

Die Unabhängigkeitserklärung aller Teilnehmer der Arbeitsgemeinschaft kann auf Wunsch bei den beteiligten Fachgesellschaften eingesehen werden. Fünf Autoren haben Vortragshonorare und/oder finanzielle Studienunterstützung erhalten respektive sind als Medical Advisor tätig gewesen. Diese Autoren haben potenzielle Interessenkonflikte gegenüber folgenden Firmen angegeben: Abbott GmbH & Co KG, Aspect Medical Systems GmbH, Arrow Deutschland GmbH, Covidien GmbH, B. Braun Melsungen AG, Deltex Medical Limited, Dräger AG & Co. KGaA, Fresenius SE, GlaxoSmithKline GmbH & Co KG, Pulsion Medical Systems AG.

Diese Leitlinie wurde von der DGTHG und der DGAI unabhängig von Interessensgruppen finanziert.

Author information

Authors and Affiliations

  1. Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Universitätsmedizin Berlin, Charité Mitte und Campus Virchow Klinikum, Berlin, Charitéplatz 1, 10117, Berlin, Deutschland

    M. Carl, J. Braun, J. Erb, J. Grosse, M. Kastrup &  C. Spies

  2. Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Rostock, Rostock, Deutschland

    A. Alms

  3. Institut für Anästhesiologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland

    A. Dongas & U. Schirmer

  4. Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    A. Goetz, M. Goepfert & D. Reuter

  5. Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Münster, Münster, Deutschland

    W. Gogarten

  6. Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland

    A.R. Heller

  7. Klinik für Anästhesiologie, Universität Lübeck, Lübeck, Deutschland

    M. Heringlake

  8. Klinik für Herz- und Thoraxchirurgie, Uniklinik Köln, Köln, Deutschland

    A. Kroener

  9. Department of Anesthesiology, VU University Hospital Center, Amsterdam, Die Niederlande

    S.A. Loer

  10. Klinik für Thorax- und Kardiovaskuläre Chirurgie, Westdeutsches Herzzentrum Essen, Essen, Deutschland

    G. Marggraf

  11. Abteilung für Herz- und Gefäßchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Deutschland

    A. Markewitz

  12. Klinik für Herzchirurgie, Universität Leipzig Herzzentrum, Leipzig, Deutschland

    D.V. Schmitt

  13. Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Regensburg, Deutschland

    C. Wiesenack

  14. Klinik für Anästhesiologie, Ludwig –Maximilians-Universität, München, Deutschland

    B. Zwissler

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  1. M. Carl
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  2. A. Alms
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  3. J. Braun
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  18. D.V. Schmitt
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  19. U. Schirmer
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  20. C. Wiesenack
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  21. B. Zwissler
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  22. C. Spies
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Correspondence to C. Spies.

Additional information

Die Langfassung der Leitlinie in deutscher Sprache ist unter http://www.leitlinien.net/ verfügbar.

Die Kurzfassung ist frei zugänglich unter http://www.egms.de/en/journals/gms/2010-8/000101.shtml und erscheint parallel als Supplement der Zeitschrift Anästhesiologie & Intensivmedizin, Ausgabe 10/2010.

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Carl, M., Alms, A., Braun, J. et al. S3-Leitlinie zur intensivmedizinischen Versorgung herzchirurgischer Patienten. Z Herz- Thorax- Gefäßchir 24, 294–310 (2010). https://doi.org/10.1007/s00398-010-0790-1

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