Zusammenfassung
Die Anwendung inhalativer Vasodilatatoren in der Intensivmedizin ist eine wirkungsvolle Therapieoption, um eine Senkung des pulmonalarteriellen Drucks bei stabilem arteriellem Druck zu erzielen. Stickstoffmonoxid (NO) war die erste diesbezüglich angewendete Substanz, die außerdem eine Verbesserung des Gasaustauschs bewirkte. Eine Vielzahl von Studien konnte die Wirksamkeit von inhaliertem NO, aber auch anderen aerosolierten Vasodilatatoren (z. B. Prostazyklin, Phosphodiesterasehemmer, Nitrate) bei der Behandlung von Patienten mit pulmonaler Hypertonie, Rechtsherzversagen und Hypoxämie belegen. Klinische Zulassungen liegen bisher für inhaliertes NO lediglich zur Behandlung der primär pulmonalen Hypertension des Neugeborenen und für das stabile Prostazyklin-Analogon Iloprost (Ventavis®) zur inhalativen Behandlung der primär pulmonalen Hypertonie vor. Andererseits führt die gute klinische Wirksamkeit inhalierter Vasodilatatoren zu einem zunehmenden „Off-label-Gebrauch“ dieser Substanzen, besonders im Bereich der Intensivmedizin. Ziel der vorliegenden Übersicht ist es daher, nach einer Einführung in die pathophysiologischen und pharmakologischen Grundlagen des Therapiekonzepts die aktuelle Studienlage und praktische Anwendung, besonders in der kardiochirurgischen Intensivmedizin, zu erläutern.
Summary
The use of inhaled vasodilators in intensive care medicine is an effective therapeutical option to decrease pulmonary pressure while maintaining a stable artery pressure. Nitric oxide (NO) was the first substance applied in this context causing an improved oxygenation. Many studies have evaluated the effects of inhaled NO as well as other aerosolized vasodilators (e. g. prostacyclin, phosphodiesterase inhibitors, nitrates) in the treatment of patients suffering from pulmonary hypertension, right heart failure and hypoxemia. However, primary pulmonary hypertension of the newborn is the only indication for which NO, and primary pulmonary hypertension for which the stable prostacyclin analogue iloprost (Ventavis®) have been clinically approved so far. On the other hand, good clinical efficacy of inhaled vasodilators has resulted in an increasing “off label” use of this concept, paticularly with respect to intensive care medicine. The present article aims to review both the pathophysiological and pharmacological basis of inhaled vasodilators and to critically evaluate their potential clinical indications especially for intensive care medicine in cardiac surgery.
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Czeslick, E., Hentschel, T., Friedrich, I. et al. Inhalative Vasodilatatoren in der kardiochirurgischen Intensivmedizin. Z Herz- Thorax- Gefäßchir 19, 132–145 (2005). https://doi.org/10.1007/s00398-005-0497-x
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DOI: https://doi.org/10.1007/s00398-005-0497-x