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S3-Leitlinie zur intensivmedizinischen Versorgung herzchirurgischer Patienten

Hämodynamisches Monitoring und Herz-Kreislauf – ein Update

S3 guidelines on intensive medical care of cardiac surgery patients

Hemodynamic monitoring and cardiovascular system—an update

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Zusammenfassung

Im Januar dieses Jahres wurde ein Update der „S3-Leitlinie zur intensivmedizinischen Versorgung herzchirurgischer Patienten – Hämodynamisches Monitoring und Herz-Kreislauf“ durch die AWMF veröffentlicht. Das Update ist eine Weiterentwicklung der Leitlinien aus den Jahren 2006 und 2011. Die Leitlinie umfasst 9 Kapitel, die sich neben den verschiedenen Monitoring-Verfahren auch mit den Fragen nach der Volumentherapie und vasoaktiven und inotropen Substanzen beschäftigt und Zielparameter der Herz-Kreislauf-Therapie definiert. Im vorliegenden Beitrag werden die wichtigsten Neuerungen der umfangreichen Leitlinie dargestellt.

Abstract

An update of the S3- guidelines for treatment of cardiac surgery patients in the intensive care unit, hemodynamic monitoring and cardiovascular system was published by the Association of Scientific Medical Societies in Germany (AWMF) in January 2018. This publication updates the guidelines from 2006 and 2011. The guidelines include nine sections that in addition to different methods of hemodynamic monitoring also reviews the topic of volume therapy as well as vasoactive and inotropic drugs. Furthermore, the guidelines also define the goals for cardiovascular treatment. This article describes the most important innovations of these comprehensive guidelines.

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Abbreviations

AKI:

akutes Nierenversagen

AWMF:

Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften

BÄK:

Bundesärztekammer

CABG:

„coronary artery bypass grafting“

DGAI:

Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin

DGF:

Deutsche Gesellschaft für Fachkrankenpflege

DGTHG:

Deutsche Gesellschaft für Thorax‑, Herz- und Gefäßchirurgie

DIVI:

Deutsche interdisziplinäre Vereinigung für Intensivmedizin

EKG:

Elektrokardiogramm

GEDVI:

globaler endiastolischer Volumenindex

GoR:

„grade of recommendation“, Empfehlungsgrad

LCOS:

Low-cardiac-output-Syndrom

LL:

Leitlinie

LV-EDAI:

„left ventricular enddiastolic area index“

LVEF:

linksventrikuläre Ejektionsfraktion

MAD:

mittlerer arterieller Blutdruck

PAK:

Pulmonaliskatheter

PAOP:

„pulmonary arterial occlusion pressure“

PPV:

„pulse pressure variation“

PVR:

„peripheral vascular resistence“

SVI:

Schlagvolumenindex

SVR:

„systemic vascular resistence“

SVV:

Schlagvolumenvarianz

S(z)vO2 :

(zentral-)venöse Sauerstoffsättigung

ZVD:

zentraler Venendruck

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Author information

Authors and Affiliations

  1. Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Gießen, Rudolf-Buchheim-Straße 7, 35392, Gießen, Deutschland

    M. Habicher,  T. Zajonz &  M. Sander

  2. Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité – Universitätsmedizin Berlin, Charité Campus Mitte und Campus Virchow Klinikum, Berlin, Deutschland

    M. Habicher &  S. Treskatsch

  3. Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland

    M. Heringlake

  4. Klinik für Herz- und Gefäßchirurgie, Universitätsklinikum Gießen, Gießen, Deutschland

    A. Böning

  5. Herz- und Diabeteszentrum NRW Institut für Anästhesiologie, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland

    U. Schirmer

  6. Klinik für Herz- und Gefäßchirurgie, Bundeszentralwehrkrankenhaus Koblenz, Koblenz, Deutschland

    A. Markewitz

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  1. M. Habicher
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  2. T. Zajonz
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  3. M. Heringlake
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  5. S. Treskatsch
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  7. A. Markewitz
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  8. M. Sander
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Corresponding author

Correspondence to M. Sander.

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Interessenkonflikt

M. Habicher gibt an, Honorare für Vortragstätigkeiten von Pulsion Medical Systems und Edwards Lifesciences erhalten zu haben. M. Heringlake gibt an, Honorare für Beratertätigkeiten oder Vortragstätigkeiten von Covidien- Medtronic, Orion Pharma, Tenax Pharma und Gambro Hospal erhalten zu haben. Weiterhin gibt M. Heringlake an, finanzielle Zuwendungen (Drittmittel) für Forschungsvorhaben von Air Liquide Sante erhalten zu haben. A. Böning gibt an, Honorare für Vortragstätigkeiten von Maquet AG, Bayer, Orion Pharma erhalten zu haben. S. Treskatsch gibt an, Honorare im Rahmen von Gutachtertätigkeiten oder Vortagstätigkeiten von Carinopharm und Edwards Lifesciences erhalten zu haben. Weiterhin gibt S. Treskatsch an, finanzielle Zuwendungen (Drittmittel) für Forschungsvorhaben von B. Braun, Biosense Webster und ImaCor erhalten zu haben. M. Sander gibt an, Honorare im Rahmen von Gutachtertätigkeiten oder Vortagstätigkeiten von Ratiopharm, Massimo, Amomed, Edwards Lifesciences, Pulsion Medical Systems und Fresenius erhalten zu haben. Weiterhin gibt M. Sander an, finanzielle Zuwendungen (Drittmittel) für Forschungsvorhaben von Edwards Lifesciences, Pulsion Medical Systems und The Medicine Company erhalten zu haben. T. Zajonz, U. Schirmer und A. Markewitz geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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M. Habicher und T. Zajonz haben gleichermaßen zur Erstellung des Manuskripts beigetragen.

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Habicher, M., Zajonz, T., Heringlake, M. et al. S3-Leitlinie zur intensivmedizinischen Versorgung herzchirurgischer Patienten. Anaesthesist 67, 375–379 (2018). https://doi.org/10.1007/s00101-018-0433-6

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