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Review
. 2021 Nov;116(8):665-671.
doi: 10.1007/s00063-021-00872-7. Epub 2021 Oct 4.

["Intravascular space contracted-tissue space expanded": interstitial edema and fluid management in intensive care medicine]

[Article in German]
Gunnar Schley  1 , Carsten Willam  2
Affiliations
Review

["Intravascular space contracted-tissue space expanded": interstitial edema and fluid management in intensive care medicine]

[Article in German]
Gunnar Schley et al. Med Klin Intensivmed Notfmed. 2021 Nov.

Abstract
in English, German

In the second phase of shock therapy, we regularly find fluid overload with edema in our patients, which not only involves the skin and interstitial tissue but can also impair kidney, liver and pulmonary function. Revision of the Starling principle and new insights into physiology of the endothelial glycocalyx have important implications for fluid therapy in intensive care medicine. Determination of fluid overload and an appropriate therapy with either diuretics or ultrafiltration are the focus of "late goal-directed fluid removal" management.

In der zweiten Phase der Schocktherapie liegt regelmäßig eine Flüssigkeitsüberladung mit Ödemen vor, die nicht nur die Haut und Bindegewebe betreffen, sondern auch Organfunktionen u. a. der Nieren, Lunge und Leber beeinträchtigen. Neue Erkenntnisse zum revidierten Starling-Prinzip und der endothelialen Glykokalyx haben Implikationen für eine adäquate Flüssigkeitstherapie in der zweiten Phase der Sepsis. Die Diagnose einer Flüssigkeitsüberladung sowie eine sachgerechte Diuretika- oder Ultrafiltrationstherapie sind Schwerpunkte eines „Late goal-directed fluid removal“-Managements.

Keywords: Critical care; Endothelial cells; Fluid therapy; Sepsis; Shock.

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References

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