title: [Volume replacement in intensive care medicine].
abstract: Volume substitution represents an essential component of intensive care medicine. The amount of fluid administered, the composition and the timing of volume replacement seem to affect the morbidity and mortality of critically ill patients. Although restrictive volume strategies bear the risk of tissue hypoperfusion and tissue hypoxia in hemodynamically unstable patients liberal strategies favour the development of avoidable hypervolemia with edema and resultant organ dysfunction. However, neither strategy has shown a consistent benefit. In order to account for the heavily varying oxygen demand of critically ill patients, a goal-directed, demand-adapted volume strategy is proposed. Using this strategy, volume replacement should be aligned to the need to restore tissue perfusion and the evidence of volume responsiveness. As the efficiency of volume resuscitation for correction of tissue hypoxia is time-dependent, preload optimization should be completed in the very first hours. Whether colloids or crystalloids are more suitable for this purpose is still controversially discussed. Nevertheless, a temporally limited use of colloids during the initial stage of tissue hypoperfusion appears to represent a strategy which uses the greater volume effect during hypovolemia while minimizing the risks for adverse reactions.
authors.affiliation: Klinik für Anaesthesiologie und Intensivmedizin, Universitätsklinikum Tübingen, Deutschland. boris.nohe@med.uni-tuebingen.de
authors.forename: B
authors.initials: B
authors.lastname: Nohé
authors.forename: A
authors.initials: A
authors.lastname: Ploppa
authors.forename: V
authors.initials: V
authors.lastname: Schmidt
authors.forename: K
authors.initials: K
authors.lastname: Unertl
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D001810:Blood Volume / Q000502:physiology*; D002311:Cardiomyopathy, Dilated / Q000209:etiology / Q000628:therapy; D002763:Cholecystectomy; D003102:Colloids / Q000627:therapeutic use; D003422:Critical Care / Q000379:methods*; D006040:Goals; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007262:Infusions, Intravenous; D019344:Lactic Acid / Q000097:blood; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000628:therapy; D010100:Oxygen / Q000097:blood; D010195:Pancreatitis / Q000150:complications; D010952:Plasma Substitutes / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000628:therapy; D012039:Regional Blood Flow / Q000502:physiology; D018805:Sepsis / Q000628:therapy; D012772:Shock, Septic / Q000628:therapy; D014556:Urine / Q000502:physiology; D014947:Wounds and Injuries / Q000150:complications / Q000628:therapy
chemical_list: D003102:Colloids; D010952:Plasma Substitutes; D019344:Lactic Acid; D010100:Oxygen