Adäquate Volumensubstitution bei septischem Schock unter hohen Katecholamindosen

Abstract

It is possible to wean a substantial proportion of septic shock patients from high-dose catecholamines in combination with a needs-adapted forced volume challenge test. The importance of appropriate fluid loading prior to the use of high catecholamine doses should be a main subject of discussion in patients with severe septic shock and was confirmed in this study. This should be oriented to clinical and if possible, hemodynamic parameters and should not be underestimated.

Impact of CytoSorb Hemoadsorption Therapy on Fluid Balance in Patients with Septic Shock

“…When considering fluid balance with correlation analysis, we found that lower reductions, which might be indicative of a less effective response to hemoadsorption but also caused by various other factors in the clinical course of the patient, were associated with almost constant norepinephrine requirements and a higher treated blood volume, suggesting that, despite fluid resuscitation and hemoadsorption therapy, vasopressor demands remained worse. In this regard, Lewejohanns and colleagues described the importance of appropriate fluid loading prior to the use of high catecholamine doses and on the influence of catecholamine demand [ 29 ]. This essentially means that if the effect on catecholamine demand is absent despite fluid resuscitation and if the fluid balance remains high, that the endothelium remains permeable and a potential positive effect of hemoadsorption is not present in these patients.…”