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. 2023 Mar;118(2):163-171.
doi: 10.1007/s00063-022-00976-8. Epub 2023 Jan 4.

[Fluid and vasopressor therapy in sepsis]

[Article in German]
Sirak Petros  1
Affiliations

[Fluid and vasopressor therapy in sepsis]

[Article in German]
Sirak Petros. Med Klin Intensivmed Notfmed. 2023 Mar.

Abstract
in English, German

Sepsis is one of the most common and lethal conditions in intensive care medicine. Besides adequate treatment of the infection, timely hemodynamic management is essential to treat tissue hypoperfusion due to sepsis. Adequate fluid resuscitation plays a central role, and this should be carried out with dynamic monitoring of the hemodynamic response. However, a positive fluid balance is associated with poor outcome. Vasopressor therapy is required in case of inadequate response to fluid resuscitation, with norepinephrine considered the first choice. With increasing norepinephrine dose, addition of hydrocortisone or vasopressin may contribute to maintaining the hemodynamic state, although the prognostic advantage of these drugs has not been demonstrated. While dobutamine may be considered in patients with septic cardiomyopathy, the evidence for inotropic therapy in sepsis is limited.

Sepsis ist eine der häufigsten und letalen Krankheitsbilder in der Intensivmedizin. Infolge der Sepsis kommt es oft zur Gewebeminderperfusion, sodass neben der adäquaten Therapie der Infektion die frühzeitige hämodynamische Therapie essenziell ist. Dabei spielt die adäquate Volumentherapie eine zentrale Rolle. Die Volumengabe sollte unter dynamischer Kontrolle des hämodynamischen Ansprechens erfolgen. Allerdings ist eine positive Flüssigkeitsbilanz mit einer schlechten Prognose assoziiert. Bei unzureichendem Ansprechen auf die Volumentherapie kommt die Vasopressortherapie zum Einsatz, wobei das Noradrenalin als der Vasopressor der Wahl gilt. Bei steigendem Noradrenalinbedarf können Hydrokortison oder Vasopressin zur Aufrechterhaltung des Kreislaufs beitragen, allerdings ist deren prognostischer Vorteil nicht bewiesen. Dobutamin kann bei Patienten mit septischer Kardiomyopathie in Betracht kommen, jedoch ist die Evidenz für eine Inotropikatherapie bei Sepsis limitiert.

Keywords: Cardiotonic agents; Fluid therapy; Hemodynamics; Septic shock; Vasoconstrictor agents.

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