Perioperatives und periinterventionelles Volumenmanagement

Eine Flüssigkeitsapplikation ist eine der grundlegenden und am häufigsten durchgeführten medizinischen Therapien im klinischen Alltag. Ein optimales Volumenmanagement bleibt aber eine Herausforderung: die Applikation ist zwar einfach, allerdings ist das Volumenmanagement insgesamt ein komplexer Prozess, der die zugrunde liegende Pathophysiologie einbeziehen muss. Der folgende Beitrag gibt einen Überblick über wichtige Maßnahmen.

Abstract

Fluid therapy is one of the basic and most frequently performed medical therapies in everyday clinical practice. However, optimal volume management is a challenge: the application is simple, but the whole volume management is a complex process and physicians have to pay attention on underlying pathophysiology. Intravenous fluids should be prescribed like medications, i. e. the type of fluid and the amount must be adapted to each individual patient with his needs. Intravascular volume therapy is often used peri-operatively and peri-interventionally.

Nowadays, crystalloid solutions are widely used and the standard is a balanced electrolyte solution. Only in selected situations 0,9 % sodium chloride solutions should be used, because they contain a high chloride concentration (154 mmol/l) and lead to increased risk of hyperchloremic metabolic acidosis.

Schlüsselwörter

Volumenmanagement - perioperativ - periinterventionell - Kristalloide - Kolloide

Key words

volume management - peri-operative - peri-interventional - crystalloids - colloids

Publication History

Article published online:
14 April 2021

• Literatur

• 1 Semler MW, Kellum JA. Balanced Crystalloid Solutions. Am J Respir Crit Care Med 2019; 199: 952-960
• 2 Yunos NM, Bellomo R, Hegarty C. et al. Association Between a Chloride-Liberal vs Chloride-Restrictive Intravenous Fluid Administration Strategy and Kidney Injury in Critically Ill Adults. JAMA 2012; 308 (15) 1566-1572
• 3 Semler MW, Wanderer JP, Ehrenfeld JM. et al. SALT Investigators; Pragmatic Critical Care Research Group. Balanced crystal-loids versus saline in the intensive care unit: the SALT randomized trial. Am J Respir Crit Care Med 2017; 195: 1362-1372
• 4 Semler MW, Self WH, Wanderer JP. et al. Balanced crystalloids versus saline in critically ill adults. N Engl J Med 2018; 378: 829-839
• 5 Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin. S 3 – Leitlinie intravasale Volumentherapie beim Erwachsenen. AWMF-Registriernummer 001-020.
• 6 Trinooson D, Gold M. Impact of goal-directed perioperative fluid management in high-risk surgical procedures a literature review. AANA J 2013; 81 (05) 357-368
• 7 Myles PS, Bellomo R, Corcoran T. et al. Restrictive versus Liberal Fluid Therapy for Major Ab-dominal Surgery. N Engl J Med 2018; 378 (24) 2263-2274
• 8 Futier E, Garot M, Godet T. et al. Effect of Hydroxyethyl Starch vs. Saline for Volume Replace-ment Therapy on Death or Postoperative Complications Among High-Risk Patients Undergoing Major Abdominal Surgery. The FLASH Randomized Clinical Trial. JAMA 2020; 323 (03) 225-236
• 9 Hiremth S, Kong J, Clark EG. Contrast and acute kidney injury: what is left to enhance?. Nephrol Dial Transplant 2020; gfaa183 DOI: 10.1093/ndt/gfaa183. [Online ahead of print]
• 10 Moritz ML, Ayus JC. Maintenance Intravenous Fluids in Acutely Ill Patients. N Engl J Med 2015; 373 (14) 1350-1360
• 11 Vincent JL, Pelosi P, Pearse R. et al. Perioperative cardiovascular monitoring of high-risk patients: a consensus of 12. Crit Care 2015; 19 (01) 224
• 12 Vincent JL. Fluid management in the critically ill. Kidney Int 2019; 96 (01) 52-57
• 13 Brunkhorst FM, Weigand MA, Pletz M. et al S3 Guideline Sepsis-prevention, diagnosis, therapy, and aftercare. Med Klin Intensivmed Notfmed 2020; 115 (Suppl. 02) 37-109 . doi:10.1007/s00063-020-00685-0