Under pressure – Der Stellenwert des zentralen Venendrucks in der modernen Intensivmedizin

Kernaussagen

• Um aus dem ZVD therapeutische Schlüsse ziehen zu können, sind einige Dinge zu beachten: (1) technisch korrekte Messung, (2) Berücksichtigung intrathorakaler Druckverhältnisse und (3) Berücksichtigung dynamischer Faktoren (u. a. Venentonus). Die Bewertung des ZVD, v. a. bei plötzlichen Änderungen, muss zwingend unter Kenntnis möglicher Fehlerquellen und im klinischen Kontext des Patienten erfolgen.

• Die zentrale Venenpulskurve weist einen typischen Verlauf, gekennzeichnet durch Wellen und Senken, auf. Pathologien können sich in charakteristischen Veränderungen des Kurvenverlaufs zeigen. Daher können aus der Analyse der zentralen Venenpulskurve wertvolle Informationen über den Patienten gewonnen werden.

• Als alleiniger Parameter ist der zentrale Venendruck nicht geeignet, Aussagen über den Volumenstatus und die Volumenreagibilität zu treffen. Des Weiteren ist die Steuerung einer Volumentherapie einzig am ZVD obsolet und wahrscheinlich schädlich, da eine mögliche venöse Kongestion zu Organfunktionsstörungen beitragen kann.

• In bestimmten Patientenkollektiven (u. a. Sepsis und Herzinsuffizienz) ist der zentrale Venendruck ein relevanter Indikator für die Entwicklung von Komplikationen und ein Prädiktor des Outcomes.

• Die aktive Senkung des ZVD zur Vermeidung der mit venöser Kongestion assoziierten Komplikationen ist Gegenstand aktueller Forschung.

• Da der ZVD beim intensivmedizinischen Patienten insgesamt v. a. ein prognostischer Marker ist und bisher keine ausreichende Evidenz zur Therapiesteuerung anhand des ZVD vorliegt, sollte auf die Anlage eines ZVK zur alleinigen Messung des ZVD verzichtet werden.

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