Welche Bedeutung besitzen hyperosmolare-hyperonkotische NaCl-Lösungen für Rettungswesen und Intensivmedizin?

Zusammenfassung

Hypertone-hyperonkotische NaCl-Lösungen bieten insbesondere im Rettungswesen zur Stabilisierung hämodynamisch instabiler Patienten bemerkenswerte Vorteile im Vergleich zu herkömmlichen kristalloiden und kolloidalen Volumenersatzlösungen. Durch eine rasche Volumenmobilisation aus dem interstitiellen und intrazellulären Kompartiment nach intravaskulär und durch Entzug von Wasser aus Endothelzellen sowie Erythrozyten werden die pathophysiologischen Vorgänge des Schockgeschehens durchbrochen mit gleichzeitiger nachhaltiger Verbesserung der Mikrozirkulation. Auch in der Behandlung des Hirnödems mit der Gefahr eines pathologisch relevanten Anstieges des intrakraniellen Druckes stellt die Infusion einer hypertonen NaCl-Lösung eine viel versprechende Alternative zu bisher angewandten Osmodiuretika dar. Künftige Untersuchungen müssen zeigen, ob das Spektrum der Indikationen für hypertone Kochsalzlösungen durch modifizierte Dosierungen und Anwendungen erweitert werden kann.

Abstract

In emergency care compared to the currently applied isotonic crystalloid and/or colloidal fluids the use of hypertonic-hyperoncotic saline solutions provides considerable advantages to improve hemodynamic instability. Due to the ability to rapidly expand plasma volume by a mobilization of interstitial and intracellular fluid into the intravascular space and a withdrawal of water out of erythrocytes and endothelial cells the pathophysiologal processes of hypovolemic shock can be interrupted instantaneously. In addition, the disturbed microcirculation can be improved substantially. Furthermore, an increase of the intracranial pressure due to a cerebral edema can be treated effectively using hypertonic saline solution. Future investigations possibly offering new insights in the potentials of hypertonic-hyperoncotic saline solutions may provide a broader spectrum of possible indications in different diseases.

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