Hämodynamisches Management: Katecholamine und andere Vasopressoren/Inotropika

Der Beitrag diskutiert die Grundlagen zur hämodynamischen Überwachung und Behandlung bei verschiedenen intensivmedizinischen Erkrankungen, insbesondere beim kardiogenen und septischen Schock. Die genaue hämodynamische Phänotypisierung der Patienten kann bei der medikamentösen Schocktherapie hilfreich sein. Für die Diagnose ist kein invasives hämodynamisches Monitoring zwingend notwendig. Dennoch bleiben das PiCCO- und das Pulmonalarterienkatheter-Verfahren weiterhin Standard in der hämodynamischen Überwachung.

Kernaussagen

• Bei der Therapie mit Katecholaminen gilt: so wenig wie möglich, so viel wie nötig.

• Anstelle einer Erhöhung der Noradrenalin-Dosis kann Vasopressin hinzugefügt werden.

• Für manche Diagnosestellungen, wie z. B. beim kardiogenen Schock, ist laut S3-Leitlinie kein invasives hämodynamisches Monitoring notwendig!

• In geeigneten Fällen kann ein erweitertes hämodynamisches Monitoring hilfreich sein.

• Vasodilatatoren sollten sehr vorsichtig eingesetzt werden. Hypotonien sollten vermieden werden.

• Noradrenalin wird Adrenalin gegenüber als Vasopressor bevorzugt.

• Dopamin wird nicht mehr empfohlen.

• Dobutamin ist das am meisten verwendete Inotropikum.

• Bei ausgewählten Patienten kann die additive Gabe von Levosimendan oder PDE-III-Inhibitoren hilfreich sein.

Schlüsselwörter

piCCO (Pulse Contour Cardiac Output) - Katecholamine - Vasopressoren - Inotropika - Schockbehandlung

Publication History

Article published online:
10 October 2023

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