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Volumentherapie, Vasopressoren und Inotropika

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Sepsis und MODS

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Zusammenfassung

Primäres Ziel einer Kreislauftherapie ist ein Wiederherstellen bzw. Aufrechterhalten eines adäquaten Sauerstoffangebotes. Parameter, die eine Einschätzung der Organfunktion und -oxygenierung erlauben (ScvO2, Laktat, Diurese), sind daher sinnvolle Parameter zur Therapiesteuerung. Aufgrund eines häufig sehr ausgeprägten intravasalen Volumenmangels ist die Volumentherapie wesentlicher Bestandteil der Stabilisierung. Grundlegendes Prinzip ist eine Erhöhung des Herzzeitvolumens und damit des O2-Angebotes mittels einer Verbesserung der myokardialen Vorlast. Es sollten ausschließlich kristalline Flüssigkeiten verwendet werden.

Bei ausgeschöpfter Volumentherapie kann mittels Dobutamin eine weitere Steigerung des HZV versucht werden. Auch die Erythrozytentransfusion ist grundsätzlich in der Lage, das O2-Angebot zu erhöhen. Jedoch besteht auch bei septischen Patienten keine Notwendigkeit, die Hb-Konzentration generell über 7 g/dl anzuheben. Vasopressor der Wahl bei Sepsis ist Noradrenalin.

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Authors and Affiliations

  1. Anästhesie, Intensivmedizin und Schmerztherapie, Helios-Klinikum Erfurt, Nordhäuser Straße 74, 99089, Erfurt, Deutschland

    Prof. Dr. med. Andreas Meier-Hellmann

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  1. Prof. Dr. med. Andreas Meier-Hellmann
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Correspondence to Andreas Meier-Hellmann .

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Editors and Affiliations

  1. Department für Innere Medizin, Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle(Saale) der Martin-Luther-Universität Halle-Wittenberg, Halle(Saale), Germany

    Karl Werdan

  2. Lehrstuhl für Geriatrie, Charité-Universitätsmedizin Berlin und Evangelisches Geriatriezentrum Berlin gGmbH, Berlin, Berlin, Germany

    Ursula Müller-Werdan

  3. Hildesheim, Germany

    Hans-Peter Schuster

  4. Zentrum für Klinische Studien, Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Jena, Germany

    Frank M. Brunkhorst

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Meier-Hellmann, A. (2016). Volumentherapie, Vasopressoren und Inotropika. In: Werdan, K., Müller-Werdan, U., Schuster, HP., Brunkhorst, F. (eds) Sepsis und MODS. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-45148-9_8

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