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Beatmung und Hämodynamik

  • U. Jensen
  • H. Forst
Conference paper

Zusammenfassung

Die maschinelle Beatmung von Patienten mit akuter respiratorischer Insuffizienz bewirkt über die Erhöhung des transpulmonalen Drucks eine Zunahme der funktionellen Residualkapazität, der pulmonalen Compliance und eine Abnahme der venösen Beimischung im arteriellen Blut (Tabelle 1). Insgesamt führen diese Effekte zu einer Verbesserung des Gasaustausches in der Lunge. Jedoch steht einer Steigerung des arteriellen O2-Gehalts u.U. ein Abfall des Herzzeitvolumens (HZV) gegenüber [2,38,53,55]. So können selbst bei positiver Beeinflussung des arteriellen O2-Gehalts erhöhte intrathorakale Drücke über diesen unerwünschten Effekt zu einer Senkung der O2-Transportkapazität führen [46, 59]. Es besteht bis heute kein einheitliches pathophysiologisches Konzept über die Ursachen der hämodynamischen Nebenwirkungen von Veränderungen des extrakardialen Drucks infolge der Erhöhung des intrathorakalen Drucks durch Beatmung. Man ist auf die Interpretation von Ergebnissen angewiesen, die nur für eine bestimmte Situation repräsentativ sind und sich nicht immer zu einer generellen Regel erheben lassen. Die Gründe für eine Beeinträchtigung des HZV sind immer noch Gegenstand von Diskussionen, obwohl schon vor fast 60 Jahren experimentell eine Beziehung zwischen mechanischer Beatmung und HZV-Verminderung nachgewiesen wurde [32].

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© Springer-Verlag Berlin Heidelberg 1987

Authors and Affiliations

  • U. Jensen
  • H. Forst

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