Wo l f g a n g G . Vo e l c k e l
Neue Therapieansätze in der Behandlung des hämorrhagischen Schocks S U M M A RY Since the outcome of hemorrhagic shock is determined by the organism's ability to compensate a certain blood loss, several promising developments interfere with physiologic mechanisms, which render survival more likely. As such, four major potentially promising approaches to advanced trauma life support can be identified. First, control of hemorrhage by administration of local hemostatic agents, and a better, targetcontrolled management of the coagulation system. Second, improving intravascular volume by recruiting blood from the venous vasculature by preventing mistakes during mechanical ventilation, and by employing alternative spontaneous (i.e. use of the inspiratory threshold valve) or artificial ventilation strategies. In addition, artificial oxygen carriers are an alternative to conventional fluid resuscitation for volume replacement, and may improve oxygen delivery. Third, pharmacologic support of physiologic, endogenous mechanisms that are involved in the compensation phase of shock, and blockade of pathomechanisms that are known to cause irreversible vasoplegia. To date, arginine vasopressin and KATP channel blockers are the most promising drugs for hemodynamic stabilization of hemorrhagic shock. Fourth, employing potentially protective strategies such as mild or moderate hypothermia. Finally, the ultimate vision of trauma resuscitation is the concept of “suspended animation”, which consists of preservation (using hy-pothermia with or without drugs) of viability of the brain, heart, and organism, which increases the time available for resuscitative surgery followed by delayed resuscitation. Keywords: Hemorrhagic shock, hypovolemia, trauma, control of hemorrhage artificial oxygen carrier, vasopressin
Z U S A M M E N FA S S U N G Der hämorrhagische Schock wird mit Gegenregulationsmechanismen des Organismus beantwortet, welche zumindest ein temporäres Überleben ermöglichen. Neue Therapiestrategien abseits der klassischen Volumensubstitution können dort ansetzen, wo physiologische Kompensationsmechanismen unterstützt oder Dekompensationsmechanismen unterbrochen werden müssen. Insgesamt kön-
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