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).
Literatur
-
1
Payen D, de Pont A C, Sakr Y et al.
A positive fluid balance is associated with a worse outcome in patients with acute renal failure.
Crit Care.
2008;
12
R74
-
2
Wiedemann H P, Wheeler A P, Bernard G R et al.
Comparison of two fluid-management strategies in acute lung injury.
N Engl J Med.
2006;
354
2564-2575
-
3
Boyd J H, Forbes J, Nakada T A et al.
Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality.
Crit Care Med.
2011;
39
259-265
-
4
Jacob M, Rehm M, Orth V et al.
Exact measurement of the volume effect of 6 % hydoxyethyl starch 130/0.4 (Voluven) during acute preoperative normovolemic hemodilution.
Anaesthesist.
2003;
52
896-904
-
5
Rehm M, Orth V, Kreimeier U et al.
Changes in intravascular volume during acute normovolemic hemodilution and intraoperative retransfusion in patients with radical hysterectomy.
Anesthesiology.
2000;
92
657-664
-
6
Bruegger D, Jacob M, Rehm M et al.
Atrial natriuretic peptide induces shedding of endothelial glycocalyx in coronary vascular bed of guinea pig hearts.
Am J Physiol Heart Circ Physiol.
2005;
289
H1993-1999
-
7
Murphy C V, Schramm G E, Doherty J A et al.
The importance of fluid management in acute lung injury secondary to septic shock.
Chest.
2009;
136
102-109
-
8
Reid F, Lobo D N, Williams R N et al.
(Ab)normal saline and physiological Hartmann"s solution: a randomized double-blind crossover study.
Clin Sci (Lond).
2003;
104
17-24
-
9
Lobo D N, Stanga Z, Simpson J A et al.
Dilution and redistribution effects of rapid 2-litre infusions of 0.9 % (w/v) saline and 5 % (w/v) dextrose on haematological parameters and serum biochemistry in normal subjects: a double-blind crossover study.
Clin Sci (Lond).
2001;
101
173-179
-
10
Ertmer C, Rehberg S, Van Aken H, Westphal M.
Physiologische Grundlagen der perioperativen Flüssigkeitstherapie.
Intensivmed up2date.
2009;
5
9-20
-
11
Khajavi M R, Etezadi F, Moharari R S et al.
Effects of normal saline vs. lactated ringer's during renal transplantation.
Ren Fail.
2008;
30
535-539
-
12
Wilkes N J, Woolf R, Mutch M et al.
The effects of balanced versus saline-based hetastarch and crystalloid solutions on acid-base and electrolyte status and gastric mucosal perfusion in elderly surgical patients.
Anesth Analg.
2001;
93
811-816
-
13
Rivers E, Nguyen B, Havstad S et al.
Early goal-directed therapy in the treatment of severe sepsis and septic shock.
N Engl J Med.
2001;
345
1368-1377
-
14
Brunkhorst F M, Engel C, Bloos F et al.
Intensive insulin therapy and pentastarch resuscitation in severe sepsis.
N Engl J Med.
2008;
358
125-139
-
15
Schortgen F, Lacherade J C, Bruneel F et al.
Effects of hydroxyethylstarch and gelatin on renal function in severe sepsis: a multicentre randomised study.
Lancet.
2001;
357
911-916
-
16
Finfer S, Bellomo R, Boyce N et al.
A comparison of albumin and saline for fluid resuscitation in the intensive care unit.
N Engl J Med.
2004;
350
2247-2256
-
17
Dellinger R P, Levy M M, Carlet J M et al.
Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008.
Intensive Care Med.
2008;
34
17-60
-
18
Reinhart K, Brunkhorst F M, Bone H G et al.
Prevention, diagnosis, treatment, and follow-up care of sepsis. First revision of the S2k Guidelines of the German Sepsis Society (DSG) and the German Interdisciplinary Association for Intensive and Emergency Care Medicine (DIVI).
Anaesthesist.
2010;
59
347-370
-
19
Michard F, Boussat S, Chemla D et al.
Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure.
Am J Respir Crit Care Med.
2000;
162
134-138
-
20
Marik P E, Cavallazzi R, Vasu T, Hirani A.
Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature.
Crit Care Med.
2009;
37
2642-2647
-
21
Cavallaro F, Sandroni C, Marano C et al.
Diagnostic accuracy of passive leg raising for prediction of fluid responsiveness in adults: systematic review and meta-analysis of clinical studies.
Intensive Care Med.
2010;
36
1475-1483
-
22
Laxenaire M C, Charpentier C, Feldman L.
Anaphylactoid reactions to colloid plasma substitutes: incidence, risk factors, mechanisms. A French multicenter prospective study.
Ann Fr Anesth Reanim.
1994;
13
301-310
-
23
Bunn F, Trivedi D, Ashraf S.
Colloid solutions for fluid resuscitation.
Cochrane Database Syst Rev.
2011;
CD001319
-
24
Alderson P, Bunn F, Li W an et al.
Human albumin solution for resuscitation and volume expansion in critically ill patients.
Cochrane Database Syst Rev.
2009;
CD001208
-
25
Delaney A P, Dan A, McCaffrey J, Finfer S.
The role of albumin as a resuscitation fluid for patients with sepsis: a systematic review and meta-analysis.
Crit Care Med.
2011;
39
386-391
-
26
Vincent J L, Sakr Y, Reinhart K et al.
Is albumin administration in the acutely ill associated with increased mortality? Results of the SOAP study.
Crit Care.
2005;
9
R745-754
-
27
Dubois M J, Orellana-Jimenez C, Melot C et al.
Albumin administration improves organ function in critically ill hypoalbuminemic patients: A prospective, randomized, controlled, pilot study.
Crit Care Med.
2006;
34
2536-2540
-
28
Dubin A, Pozo M O, Casabella C A et al.
Comparison of 6 % hydroxyethyl starch 130/0.4 and saline solution for resuscitation of the microcirculation during the early goal-directed therapy of septic patients.
J Crit Care.
2010;
25
659 e651-658
-
29
Silva E, De Backer D, Creteur J, Vincent J L.
Effects of fluid challenge on gastric mucosal PCO2 in septic patients.
Intensive Care Med.
2004;
30
423-429
-
30
The Crystalloid versus Hydroxyethyl Starch Trial. Protocol for a multi-centre randomised controlled trial of fluid resuscitation with 6 % hydroxyethyl starch (130/0.4) compared to 0.9 % sodium chloride (saline) in intensive care patients on mortality.
Intensive Care Med.
2011;
37
816-823
-
31
Perner A, Haase N, Wetterslev J et al.
Comparing the effect of hydroxyethyl starch 130/0.4 with balanced crystalloid solution on mortality and kidney failure in patients with severe sepsis (6S - Scandinavian Starch for Severe Sepsis/Septic Shock trial): Study protocol, design and rationale for a double-blinded, randomised clinical trial.
Trials.
2011;
12
24
-
32
Wesse H, Scholtan W.
Pharmacology of periston N.
Dtsch Med Wochenschr.
1951;
76
1492-1493
-
33
Bayer O, Reinhart K, Sakr Y et al.
Renal effects of synthetic colloids and crystalloids in patients with severe sepsis: A prospective sequential comparison.
Crit Care Med.
2011;
39
1335-1342
-
34
Ertmer C, Kampmeier T G, Rehberg S et al.
Effects of balanced crystalloid vs. 0.9 % saline-based vs. balanced 6 % tetrastarch infusion on renal function and tubular integrity in ovine endotoxemic shock.
Crit Care Med.
2011;
39
783-792
-
35
Ertmer C, Kohler G, Rehberg S et al.
Renal effects of saline-based 10 % pentastarch versus 6 % tetrastarch infusion in ovine endotoxemic shock.
Anesthesiology.
2010;
112
936-947
-
36
Yerram P, Karuparthi P R, Misra M.
Fluid overload and acute kidney injury.
Hemodial Int.
2010;
14
348-354
-
37
Macedo E, Bouchard J, Soroko S H et al.
Fluid accumulation, recognition and staging of acute kidney injury in critically-ill patients.
Crit Care.
2010;
14
R82
-
38
Duchesne J C, McSwain Jr. N E, Cotton B A et al.
Damage control resuscitation: the new face of damage control.
J Trauma.
2010;
69
976-990
Zusätzliche Literatur
-
39
Adrogue H J, Madias N E.
Sodium and potassium in the pathogenesis of hypertension.
N Engl J Med.
2007;
356
1966-1978
-
40
Bagshaw S M, Gibney R T, McAlister F A, Bellomo R.
The SPARK Study: a phase II randomized blinded controlled trial of the effect of furosemide in critically ill patients with early acute kidney injury.
Trials.
2010;
11
50
-
41
Bauer M, Brunkhorst F, Welte T et al.
Sepsis: Update on pathophysiology, diagnostics and therapy.
Anaesthesist.
2006;
55
835-845
-
42
Berkenstadt H, Margalit N, Hadani M et al.
Stroke volume variation as a predictor of fluid responsiveness in patients undergoing brain surgery.
Anesth Analg.
2001;
92
984-989
-
43
Bernheim B M.
Hemorrhage and blood transfusion in the war.
JAMA.
1919;
73
172-174
-
44
Boussekey N, Darmon R, Langlois J et al.
Resuscitation with low volume hydroxyethylstarch 130 kDa/0.4 is not associated with acute kidney injury.
Crit Care.
2010;
14
R40
-
45
Bruegger D, Bauer A, Rehm M et al.
Effect of hypertonic saline dextran on acid-base balance in patients undergoing surgery of abdominal aortic aneurysm.
Crit Care Med.
2005;
33
556-563
-
46
Cannon W.
The course of events in secondary wound shock.
JAMA.
1919;
73
174-181
-
47
Celik I, Duda D, Stinner B et al.
Early and late histamine release induced by albumin, hetastarch and polygeline: some unexpected findings.
Inflamm Res.
2003;
52
408-416
-
48
Cervera A L, Moss G.
Crystalloid distribution following hemorrhage and hemodilution: mathematical model and prediction of optimum volumes for equilibration at normovolemia.
J Trauma.
1974;
14
506-520
-
49
Cervera A L, Moss G.
Dilutional re-expansion with crystalloid after massive hemorrahage: saline versus balanced electrolyte solution for maintenance of normal blood volume and arterial pH.
J Trauma.
1975;
15
498-503
-
50
Chappell D, Jacob M, Becker B F et al.
Expedition glycocalyx. A newly discovered "Great Barrier Reef".
Anaesthesist.
2008;
57
959-969
-
51
Christensen P, Andersson J, Rasmussen S E et al.
Changes in circulating blood volume after infusion of hydroxyethyl starch 6 % in critically ill patients.
Acta Anaesthesiol Scand.
2001;
45
414-420
-
52
Dehne M G, Muhling J, Sablotzki A et al.
Effect of hydroxyethyl starch solution on kidney function in surgical intensive care patients.
Anasthesiol Intensivmed Notfallmed Schmerzther.
1997;
32
348-354
-
53
Dolecek M, Svoboda P, Kantorova I et al.
Therapeutic influence of 20 % albumin versus 6 % hydroxyethylstarch on extravascular lung water in septic patients: a randomized controlled trial.
Hepatogastroenterology.
2009;
56
1622-1628
-
54
Ernest D, Belzberg A S, Dodek P M.
Distribution of normal saline and 5 % albumin infusions in septic patients.
Crit Care Med.
1999;
27
46-50
-
55
Ernest D, Belzberg A S, Dodek P M.
Distribution of normal saline and 5 % albumin infusions in cardiac surgical patients.
Crit Care Med.
2001;
29
2299-2302
-
56
Erni D, Banic A, Wheatley A M, Sigurdsson G H.
Haemorrhage during anaesthesia and surgery: continuous measurement of microcirculatory blood flow in the kidney, liver, skin and skeletal muscle.
Eur J Anaesthesiol.
1995;
12
423-429
-
57
Ertmer C, Rehberg S, Van Aken H, Westphal M.
Relevance of non-albumin colloids in intensive care medicine.
Best Pract Res Clin Anaesthesiol.
2009;
23
193-212
-
58
Friedman G, Jankowski S, Shahla M et al.
Hemodynamic effects of 6 % and 10 % hydroxyethyl starch solutions versus 4 % albumin solution in septic patients.
J Clin Anesth.
2008;
20
528-533
-
59
Gao F, Melody T, Daniels D F et al.
The impact of compliance with 6-hour and 24-hour sepsis bundles on hospital mortality in patients with severe sepsis: a prospective observational study.
Crit Care.
2005;
9
R764-770
-
60
Gidding S S, Dennison B A, Birch L L et al.
Dietary recommendations for children and adolescents: a guide for practitioners: consensus statement from the American Heart Association.
Circulation.
2005;
112
2061-2075
-
61
Gondos T, Marjanek Z, Ulakcsai Z et al.
Short-term effectiveness of different volume replacement therapies in postoperative hypovolaemic patients.
Eur J Anaesthesiol.
2010;
27
794-800
-
62
Halperin B D, Feeley T W, Mihm F G et al.
Evaluation of the portable chest roentgenogram for quantitating extravascular lung water in critically ill adults.
Chest.
1985;
88
649-652
-
63
Hauser C J, Shoemaker W C, Turpin I, Goldberg S J.
Oxygen transport responses to colloids and crystalloids in critically ill surgical patients.
Surg Gynecol Obstet.
1980;
150
811-816
-
64
Hecht G, Weese H.
Periston, ein neuer Blutflüssigkeitsersatz.
MMW Munch Med Wochenschr.
1943;
90
11
-
65
Hene R J, Boer P, Koomans H A, Mees E J.
Plasma aldosterone concentrations in chronic renal disease.
Kidney Int.
1982;
21
98-101
-
66
Hiltebrand L B, Koepfli E, Kimberger O et al.
Hypotension during Fluid-restricted Abdominal Surgery: Effects of Norepinephrine Treatment on Regional and Microcirculatory Blood Flow in the Intestinal Tract.
Anesthesiology.
2011;
114
557-564
-
67
Hinder F, Stubbe H D, Van Aken H et al.
Early multiple organ failure after recurrent endotoxemia in the presence of vasoconstrictor-masked hypovolemia.
Crit Care Med.
2003;
31
903-909
-
68
Huang C C, Kao K C, Hsu K H et al.
Effects of hydroxyethyl starch resuscitation on extravascular lung water and pulmonary permeability in sepsis-related acute respiratory distress syndrome.
Crit Care Med.
2009;
37
1948-1955
-
69
Jacob M, Chappell D, Hofmann-Kiefer K et al.
Determinants of insensible fluid loss. Perspiration, protein shift and endothelial glycocalyx.
Anaesthesist.
2007;
56
747-758, 760–744
-
70
Joannidis M, Druml W, Forni L G et al.
Prevention of acute kidney injury and protection of renal function in the intensive care unit. Expert opinion of the Working Group for Nephrology, ESICM.
Intensive Care Med.
2010;
36
392-411
-
71
Kumar A, Anel R, Bunnell E et al.
Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume, cardiac performance, or the response to volume infusion in normal subjects.
Crit Care Med.
2004;
32
691-699
-
72
Marik P E, Baram M, Vahid B.
Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares.
Chest.
2008;
134
172-178
-
73
McFarlane C, Lee A.
A comparison of Plasmalyte 148 and 0.9 % saline for intra-operative fluid replacement.
Anaesthesia.
1994;
49
779-781
-
74
McIlroy D R, Kharasch E D.
Acute intravascular volume expansion with rapidly administered crystalloid or colloid in the setting of moderate hypovolemia.
Anesth Analg.
2003;
96
1572-1577
-
75
Meyer P, Pernet P, Hejblum G et al.
Haemodilution induced by hydroxyethyl starches 130/0.4 is similar in septic and non-septic patients.
Acta Anaesthesiol Scand.
2008;
52
229-235
-
76
Michard F, Alaya S, Zarka V et al.
Global end-diastolic volume as an indicator of cardiac preload in patients with septic shock.
Chest.
2003;
124
1900-1908
-
77
Mitchell J P, Schuller D, Calandrino F S, Schuster D P.
Improved outcome based on fluid management in critically ill patients requiring pulmonary artery catheterization.
Am Rev Respir Dis.
1992;
145
990-998
-
78
Molnar Z, Mikor A, Leiner T, Szakmany T.
Fluid resuscitation with colloids of different molecular weight in septic shock.
Intensive Care Med.
2004;
30
1356-1360
-
79
Neville K A, Sandeman D J, Rubinstein A et al.
Prevention of hyponatremia during maintenance intravenous fluid administration: a prospective randomized study of fluid type versus fluid rate.
J Pediatr.
2010;
156
313-319
, e311–312
-
80
Palumbo D, Servillo G, D"Amato L et al.
The effects of hydroxyethyl starch solution in critically ill patients.
Minerva Anestesiol.
2006;
72
655-664
-
81
Perel P, Roberts I.
Colloids versus crystalloids for fluid resuscitation in critically ill patients.
Cochrane Database Syst Rev.
2007;
CD000567
-
82
Perz S, Uhlig T, Kohl M et al.
Low and ”supranormal” central venous oxygen saturation and markers of tissue hypoxia in cardiac surgery patients: a prospective observational study.
Intensive Care.
2011;
37
52-59
-
83
Rehm M, Haller M, Orth V et al.
Changes in blood volume and hematocrit during acute preoperative volume loading with 5 % albumin or 6 % hetastarch solutions in patients before radical hysterectomy.
Anesthesiology.
2001;
95
849-856
-
84
Rehm M, Zahler S, Lotsch M et al.
Endothelial glycocalyx as an additional barrier determining extravasation of 6 % hydroxyethyl starch or 5 % albumin solutions in the coronary vascular bed.
Anesthesiology.
2004;
100
1211-1223
-
85
Rivers E P, Ander D S, Powell D.
Central venous oxygen saturation monitoring in the critically ill patient.
Curr Opin Crit Care.
2001;
7
204-211
-
86
Sakr Y, Payen D, Reinhart K et al.
Effects of hydroxyethyl starch administration on renal function in critically ill patients.
Br J Anaesth.
2007;
98
216-224
-
87
Schabinski F, Oishi J, Tuche F et al.
Effects of a predominantly hydroxyethyl starch (HES)-based and a predominantly non HES-based fluid therapy on renal function in surgical ICU patients.
Intensive Care Med.
2009;
35
1539-1547
-
88
Schnuelle P, Johannes van der Woude F.
Perioperative fluid management in renal transplantation: a narrative review of the literature.
Transpl Int.
2006;
19
947-959
-
89
Schortgen F, Girou E, Deye N, Brochard L.
The risk associated with hyperoncotic colloids in patients with shock.
Intensive Care Med.
2008;
34
2157-2168
-
90
Slama M, Masson H, Teboul J L et al.
Respiratory variations of aortic VTI: a new index of hypovolemia and fluid responsiveness.
Am J Physiol Heart Circ Physiol.
2002;
283
H1729-H1733
-
91
Sumpelmann R, Kretz F J, Gabler R et al.
Hydroxyethyl starch 130/0.42/6 : 1 for perioperative plasma volume replacement in children: preliminary results of a European Prospective Multicenter Observational Postauthorization Safety Study (PASS).
Paediatr Anaesth.
2008;
18
929-933
-
92
Sumpelmann R, Mader T, Eich C et al.
A novel isotonic-balanced electrolyte solution with 1 % glucose for intraoperative fluid therapy in children: results of a prospective multicentre observational post-authorization safety study (PASS).
Paediatr Anaesth.
2010;
20
977-981
-
93
Takanishi Jr. D M, Biuk-Aghai E N, Yu M et al.
The availability of circulating blood volume values alters fluid management in critically ill surgical patients.
Am J Surg.
2009;
197
232-237
-
94
Trof R J, Sukul S P, Twisk J W et al.
Greater cardiac response of colloid than saline fluid loading in septic and non-septic critically ill patients with clinical hypovolaemia.
Intensive Care Med.
2010;
36
697-701
-
95
van der Heijden M, Verheij J, van Nieuw Amerongen G P, Groeneveld A B.
Crystalloid or colloid fluid loading and pulmonary permeability, edema, and injury in septic and nonseptic critically ill patients with hypovolemia.
Crit Care Med.
2009;
37
1275-1281
-
96
Waitzinger J, Bepperling F, Pabst G et al.
Pharmacokinetics and Tolerability of a New Hydroxyethyl Starch (HES) Specification [HES (130/0.4)] after Single-Dose Infusion of 6 % or 10 % Solutions in Healthy Volunteers.
Clin Drug Investig.
1998;
16
151-160
-
97
Waters J H, Gottlieb A, Schoenwald P et al.
Normal saline versus lactated Ringer"s solution for intraoperative fluid management in patients undergoing abdominal aortic aneurysm repair: an outcome study.
Anesth Analg.
2001;
93
817-822
-
98
Wu Y, Wu A S, Wang J et al.
Effects of the novel 6 % hydroxyethyl starch 130/0.4 on renal function of recipients in living-related kidney transplantation.
Chin Med J (Engl).
2010;
123
3079-3083
-
99
Ytrebo L M.
Stop filling patients against central venous pressure, please!.
Crit Care Med.
2011;
39
396-397
Dr. med. Christian Ertmer
Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin
Universitätsklinikum Münster
Albert-Schweitzer-Str. 33
48149 Münster
Phone: 0251/83-47252
Fax: 0251/83-48667
Email: ertmerc@gmx.net
