Zielgerichtetes hämodynamisches Monitoring im OP: Wozu und womit?

Das zielgerichtete hämodynamische Monitoring und die Balance zwischen adäquater Flüssigkeits- und Volumentherapie und der Applikation vasoaktiver bzw. inotroper Medikamente sind die Grundelemente der modernen perioperativen Therapie [1] [2] [3]. Der Artikel soll einen Überblick zum derzeitigen Vorgehen und einen Ausblick auf die Zukunft des hämodynamischen Monitorings geben. Die aktuellen Möglichkeiten werden an einem Fallbeispiel diskutiert.

Abstract

Goal directed hemodynamic monitoring and the balance in goal directed therapy between adequate fluid/volume therapy and the application of vasoactive or inotropic drugs are the basic elements of modern perioperative therapy.

Surgical procedures should be accompanied by as few side effects and complications as possible. Nevertheless, the number of postoperative complications remains surprisingly high, despite of the modern surgical procedures. Anticipation of potential complications in the perioperative period and their rapid treatment build a core competence of anesthesiological action. Thus, it is clear that anesthesia plays a central role in this balancing act.

This article aims to provide an overview of the application of the currently available perioperative goal directed hemodynamic monitoring. The current possibilities are discussed by using a case example and an outlook on the future of hemodynamic monitoring is given.

Kernaussagen

• Basismonitoring ist obligat.

• Ein erweitertes Monitoring ist bei patienten- und eingriffsbezogenen Risiken sinnvoll.

• Eine hämodynamische Instabilität sollte man vermeiden.

• Der Zeitpunkt des Therapiebeginns ist entscheidend.

• Komplikationen durch Gewebehypoxie sind zu vermeiden.

• DO₂ = HZV × Hb × S_aO₂ × 1,34 + p_aO₂ × 0,0031

• Das Herzzeitvolumen ist die Hauptstellgröße des Sauerstoffangebots.

• Monitoring und Therapie gehören zusammen; Monitoring ist nur mit therapeutischem Konzept sinnvoll.

• Nutzen Sie klare protokollbasierte Algorithmen.

• Ein „ideales“ hämodynamisches Monitoring gibt es nicht.

Schlüsselwörter

hämodynamisches Monitoring - nicht-invasive Monitoringverfahren - minimalinvasive Monitoringverfahren - perioperatives Monitoring

Keywords

haemodynamic monitoring - non-invasive monitoring - minimally invasive monitoring - perioperative monitoring

Publication History

Article published online:
21 April 2022

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