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Minimal-invasives hämodynamisches Monitoring

Toy or tool?

Minimally invasive hemodynamic monitoring

Toy or tool?

  • Leitthema
  • Published:
Intensivmedizin und Notfallmedizin

Zusammenfassung

In den letzten Jahren konnte gezeigt werden, dass ein unzureichendes globales Sauerstoffangebot und die daraus resultierende Sauerstoffschuld verschiedener Organe wesentlich zur Morbidität und Mortalität intensivmedizinisch behandelter Patienten beitragen. Daher kommt der Überwachung des Sauerstoffstatus und insbesondere des Herzzeitvolumens (HZV) bei kritisch kranken Patienten eine große Bedeutung zu. Lange Zeit stellte der Pulmonalarterienkatheter die einzige Möglichkeit zur Messung des HZV dar. Aus Furcht vor den mit seinem Einsatz verbundenen Risiken wurde Patienten häufig ein erweitertes hämodynamisches Monitoring vorenthalten. Inzwischen wurde jedoch eine ganze Reihe weniger invasiver Verfahren zur Messung des HZV und/oder zur Abschätzung des Sauerstoffstatus in die klinische Routine eingeführt, sodass eine breitere Anwendung dieser Verfahren möglich erscheint. Verschiedene minimal-invasive Verfahren und die ihnen zugrunde liegende Technologie werden im vorliegenden Beitrag vorgestellt. Daneben soll gezeigt werden, wie durch den Einsatz des minimal-invasiven hämodynamischen Monitorings im Rahmen zielorientierter Therapiekonzepte das Outcome bestimmter Patientengruppen verbessert werden kann.

Abstract

Inadequate systemic oxygen delivery and the resulting oxygen debt of various organs have been demonstrated to be a major cause for the morbidity and mortality of intensive care unit patients. Hence, monitoring oxygen status and particularly cardiac output (CO) appear to be of essential importance when attempting to improve the outcome of critically ill patients. For a long time, measurement of CO was only possible with a pulmonary artery catheter. However, concerns about the inherent risks of pulmonary artery catheterization have driven the search for minimally or less invasive alternatives of hemodynamic monitoring, of which a number have been recently introduced into clinical routine. In the present review, the various new devices, including their technology and their efficacy in improving patient outcome when applying goal-directed therapy protocols, are described.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: SR hat von der Firma Edwards Lifesciences GmbH, München, Deutschland, Honorare für Vorträge und beratende Tätigkeiten erhalten. WB hat von den Firmen Pulsion Medical Systems, München, und Edwards Lifesciences GmbH, München, Deutschland, Honorare für Vorträge und beratende Tätigkeiten erhalten.

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Authors and Affiliations

  1. Klinik für Anästhesiologie, Universitätsklinikum der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland

    S. Metzelder &  S. Rex

  2. Division of Perioperative and Emergency Medicine, University Medical Center Utrecht, Utrecht, Niederlande

    E.E.C. de Waal & W. Buhre

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  1. S. Metzelder
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  2. E.E.C. de Waal
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  3. W. Buhre
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  4. S. Rex
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Correspondence to S. Rex.

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Metzelder, S., de Waal, E., Buhre, W. et al. Minimal-invasives hämodynamisches Monitoring. Intensivmed 47, 354–361 (2010). https://doi.org/10.1007/s00390-009-0146-9

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  • DOI: https://doi.org/10.1007/s00390-009-0146-9

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