Flüssigkeits- und Volumentherapie in der Intensivmedizin

Kernaussagen

Zur Deckung des Basisflüssigkeitsbedarfs von intensivmedizinisch behandelten Patienten sollte man balancierte, kristalloide Lösungen infundieren. Eine Verwendung von Humanalbumin oder synthetischen Kolloiden zur Reduktion des kumulativen Flüssigkeitsbedarfs ist aufgrund der aktuellen Datenlage nicht indiziert. Die zielgerichtete Volumentherapie sollte unter Verwendung eines erweiterten Monitorings mit sensitiven und spezifischen Markern der Volumenreagibilität (Schlagvolumenmessung, Pulskonturanalyse, transpulmonale Thermodilution oder Echokardiografie) gesteuert werden. Eine lebensbedrohliche Hypovolämie kann mit isoonkotischen Kolloiden besser behandelt werden als mit Kristalloiden.

Es ist derzeit unklar, ob durch den Einsatz von Kolloiden zur Therapie der akuten Hypovolämie das Outcome kritisch kranker Patienten beeinflusst wird. Des Weiteren ist nicht geklärt, ob man bei dieser Indikation Humanalbumin oder moderne synthetische Kolloide (z. B. 6 % HES 130/0,4 oder 130/0,42) verwenden sollte. Die potenziellen positiven Effekte einer kontinuierlichen Substitution von Humanalbumin bei hypalbuminämen Patienten sollten separat vom Volumeneffekt in klinischen Studien evaluiert werden. Bezüglich der Effekte moderner Kolloide auf die Nierenfunktion sind weitere prospektive, klinische Studien erforderlich, die die Auswirkungen auf valide Marker der Nierenfunktion und -schädigung bei indikationsgerechtem Gebrauch untersuchen (Infobox 3).

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