Anästhesiol Intensivmed Notfallmed Schmerzther 2012; 47(2): 110-117
DOI: 10.1055/s-0032-1304514
Fachwissen
Anästhesie & Intensivmedizin Topthema: Hämodynamisches Monitoring
© Georg Thieme Verlag Stuttgart · New York

Hämodynamisches Monitoring – Gibt es Indikationen für den perioperativen Einsatz des pulmonal-arteriellen Katheters?

Is there any indication for perioperative use of the pulmonary artery catheter?
Tobias Schürholz
,
Gernot Marx
Further Information

Publication History

Publication Date:
08 March 2012 (online)

Zusammenfassung

Der Nutzen des pulmonalarteriellen Katheters (PAK) wird seit mehreren Jahren kritisch hinterfragt. Die Entwicklung alternativer Monitoringtechniken vor allem für Volumenparameter hat zu einem Rückgang in der Anwendung des PAK geführt. Zahlreiche Studien belegen die Vorteile einer Therapie, die frühzeitig die Kreislaufparameter optimiert, unanhängig von der eingesetzten Monitoringtechnik. Patienten mit einem erhöhten perioperativen Risiko, vor allem im Bereich der Kardio- und Gefäßchirurgie, können trotzdem von einem PAK-Monitoring profitieren.

Die Bedenken gegenüber den erhältlichen Monitoringtechniken generieren sich vor allem aus der Invasivität. Bislang erfüllt aber keine Technik alle Anforderungen an ein ideales System.

Abstract

The benefit of the pulmonary-artery catheter (PAC) is a matter of discussion since years. The development of alternative monitoring techniques especially for measurement of volume parameters has decreased routine use of the PAC. Several investigations verified advantages of therapy attempting to optimize circulation parameters regardless of the used technique. Nonetheless, patients with a higher peri-operative risk, especially in cardiovascular surgery, may benefit from PAC monitoring intra- or postoperatively.

The concerns about the available monitoring techniques bear mainly on the fear being too invasive. Up to now, there is no technique complying with all requirements of an ideal monitoring system.

Kernaussagen

  • Die Krankenhaus-Letalität ist durch die Anlage eines PAK nicht erhöht.

  • Für Patienten mit einem geringen perioperativen Risiko ist die Anlage eines PAK entbehrlich.

  • Frühzeitige Stabilisierung und Optimierung der Kreislauftherapie kann das Langzeit-Überleben verbessern.

  • Durch verbesserte Therapie und verbessertes Monitoring kann die Letalität reduziert werden.

  • Die Auswahl des Monitorings sollte man nach dem kardialen Zustand des Patienten treffen.

  • Es gibt deutliche Unterschiede in der Bevorzugung des Monitorings zwischen den USA und Europa.

Ergänzendes Material

 
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