title: [Oxygen transport and tissue oxygenation in critically ill patients--value of volumes and vasoactive substances].
abstract: The primary function of the cardio-respiratory system is to meet the oxygen demands of the various organs and tissues and to remove metabolic wastes. The cellular O2 supply in the critically ill patient afflicted with severe infection, sepsis or ARDS is impaired not only by reduced O2 transport to the tissue due to myocardial depression caused by inadequate preloading and depressed contractility, but also by inadequate blood flow at the regional and microcirculatory levels. To obtain adequate tissue oxygenation despite derangements of the microcirculation, it is useful to aim for a hyperdynamic circulatory state that provides a supramaximal O2 transport. The best way to achieve this goal is first to optimize cardiac filling pressures, i.e. to the upper range of normal, and then to improve cardiac output using inotropic support. Only when the arterial pressure remains too low despite these measures is the use of vasopressors indicated.
authors.affiliation: Klinik für Anästhesiologie und operative Intensivmedizin, Klinikum Steglitz der FU Berlin.
authors.forename: K
authors.initials: K
authors.lastname: Reinhart
authors.forename: L
authors.initials: L
authors.lastname: Hannemann
authors.forename: A
authors.initials: A
authors.lastname: Meier-Hellmann
mesh_terms: D001810:Blood Volume / Q000187:drug effects* / Q000502:physiology; D003422:Critical Care; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D010100:Oxygen / Q000502:physiology*; D010101:Oxygen Consumption / Q000187:drug effects* / Q000502:physiology; D012039:Regional Blood Flow / Q000187:drug effects / Q000502:physiology; D012128:Respiratory Distress Syndrome / Q000188:drug therapy / Q000503:physiopathology; D012772:Shock, Septic / Q000188:drug therapy / Q000503:physiopathology; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000009:adverse effects; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; D010100:Oxygen
vernacular_title: Sauerstofftransport und Gewebeoxygenierung beim kritisch Kranken--Stellenwert von Volumen und vasoaktiven Substanzen.