Betablocker im septischen Schock

Zusammenfassung

Die Therapie von Patienten im septischen Schock birgt große Herausforderungen. Die adrenerg vermittelte Stressantwort im Körper ist komplex reguliert – ob Betablocker die Hämodynamik in der Sepsis verbessern können, ist noch offen. Dieser Beitrag gibt einen Überblick über die Pharmakologie des betaadrenergen Systems, die pathophysiologische Rationale und die aktuelle Literatur zum Betablocker-Einsatz in der Sepsis und im septischen Schock.

Abstract

The therapy of patients suffering from sepsis and septic shock is one of the greatest challenges in critical care medicine. In the initial phase of septic shock patients often present with hyperdynamic circulatory conditions with elevated cardiac index, tachycardia and progressive hemodynamic instability. The type of tachycardia differs from atrial fibrillation or flatter to sinus tachycardia. The latter might be persistent even in case of adequate volume therapy according to the surviving sepsis campaign recommendations and may represent an independent pathology due to adrenergic overstimulation. Despite predominantly β₂-mediated immunomodulatory effects the administration of a selective β₁-adrenergic blocker may be beneficial in some cases. On the other hand, incautious administration of beta-blockers especially in case of insufficient volume replacement may result in direct negative inotropic effects rapidly aggravating hypotension and shock. This review focused on pharmacology of the β-adrenergic system, the pathophysiological rationale and current literature on clinical practice of the use of beta-blockers in sepsis and septic shock.

Schlüsselwörter

Sepsis - septischer Schock - Betablocker - Metoprolol - Esmolol

Key words

sepsis - septic shock - beta-blocker - metoprolol - esmolol

• Literatur

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