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DOI: 10.1055/a-1202-9010
Säure-Basen-Störungen
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Die Blutgasanalyse liefert zeitnah adäquate Informationen bezüglich Oxygenierung, Ventilation und metabolischer Situation inkl. Elektrolyten. Die ausgezeichnete Korrelation zur Klinik ermöglicht somit auch eine rasche Optimierung der Versorgung. Der Fokus dieses Artikels liegt auf einer pragmatischen Hilfestellung der klinischen Interpretation von Blutgasanalysen als effektiv nutzbares Diagnostikum.
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Säure-Basen-Störungen sind im intensivmedizinischen Kontext häufig komplex und bedürfen einer differenzierteren Betrachtung.
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Die Wasserstoffionenkonzentration bzw. der pH-Wert werden durch das Verhältnis von CO₂ zu HCO₃− bestimmt, nicht vom absoluten Wert.
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Die klinische Manifestation von Säure-Basen-Störungen wird im Wesentlichen von der Dynamik der Entstehung und den einhergehenden Ursachen geprägt als vom Zahlenwert des pH-Wertes per se.
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Schnell zu bestimmende Parameter wie die Anionenlücke und das Delta-Gap geben Hilfestellungen bei differenzialtherapeutischen Entscheidungen.
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Bei metabolischen Störungen sollte immer die Anionenlücke bestimmt werden.
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Die Therapie von Säure-Basen-Störungen sollte sich auf die Ursache fokussieren.
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Akute respiratorische Störungen wirken sich aufgrund der erst verzögert einsetzenden renalen Kompensation deutlicher auf den pH-Wert aus als chronische.
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Bei der Entwöhnung von der Beatmung sollte bei chronisch respiratorischen Störungen die initiale HCO₃−-Konzentration beachtet werden.
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Elektrolytveränderungen (Na, K, Cl, ionisiertes Ca) sind eng mit Säure-Basen-Störungen assoziiert und sowohl diagnostisch als auch therapeutisch in den Behandlungsprozess und das Monitoring zu integrieren.
Schlüsselwörter
Intensivmedizin - metabolische Störungen - Azidose - Alkalose - respiratorische Störungen - ElektrolytstörungenPublikationsverlauf
Artikel online veröffentlicht:
19. Februar 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
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