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Die Intensivtherapie bei akutem Lungenversagen pp 62–70Cite as

Flüssigkeitstherapie beim akuten Lungenversagen

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Zusammenfassung

In der Frühphase des akuten Lungenversagens verursachen inflammatorische Mediatoren eine Permeabilitätsstörung an der alveolo-kapillären Membran. In der Folge entsteht ein nicht-kardiales Lungenödem. Die alveolo-kapilläre Membran wird für Makromoleküle permeabel und der mikrovaskuläre Druck wird entscheidend für das Ausmaß der transvaskulären Flüssigkeitsfiltration. Determinanten des mikrovaskulären Druckes sind der linksatriale Druck, der postkapilläre Lungengefäßwiderstand und das Herzzeitvolumen. Die transvaskuläre Flüssigkeitsfil tration kann durch Negativbilanz nur dann effektiv verringert werden, wenn das Herzzeitvolumen sinkt. Die Abnahme des Herzzeitvolumens birgt die Gefahr der Splanchnikusischämie mit bakterieller Translokation und des akuten Nierenversagens. Deshalb darf eine Negativbilanz nur dann erfolgen, wenn der Kreislauf stabil ist und wenn eine Hypovolämie vermieden wird. Beim Volumenersatz scheinen kristalloide Lösungen Vorteile gegenüber kolloidalen Lösungen zu haben.

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  1. Anaesthesiologische Universitätsklinik, Hugstetter Str. 55, 79106, Freiburg, Germany

    A. Benzing, G. Mols & K. Geiger

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Benzing, A., Mols, G., Geiger, K. (2003). Flüssigkeitstherapie beim akuten Lungenversagen. In: Die Intensivtherapie bei akutem Lungenversagen. Steinkopff, Heidelberg. https://doi.org/10.1007/978-3-642-57349-1_8

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