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Rationaler Einsatz von Sauerstoff in Anästhesie und Intensivmedizin

Rational use of oxygen in anesthesiology and intensive care medicine

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Zusammenfassung

Das mit Abstand am häufigsten verwendete „Pharmakon“ in Anästhesie und Intensivmedizin ist medizinischer Sauerstoff (O2): Jeder Patient wird im Rahmen eines chirurgischen Eingriffs oder während eines Aufenthalts auf der Intensivstation mit O2 behandelt. In der Gebrauchsinformation von medizinischem O2 werden Hypoxie bzw. Hypoxämie unterschiedlichster Pathogenese als Indikation zur Applikation von O2 angeführt: Ziel ist die Steigerung entweder des arteriellen Sauerstoffpartialdrucks (paO2) als Therapie einer Hypoxie oder des arteriellen Sauerstoffgehalts (CaO2) als Therapie einer Hypoxämie. Die meisten klinischen Indikationen für die Gabe von O2 haben sich historisch entwickelt und wurden für lange Zeit nur wenig hinterfragt, da für die kurzfristige Anwendung von O2 das relevante Nebenwirkungsspektrum meistens als unwesentlich betrachtet wurde. Dementsprechend existieren auch nur für sehr wenige Bereiche randomisierte kontrollierte Studien, die nach Maßstäben der evidenzbasierten Medizin den Nutzen supraphysiologischer Konzentrationen von O2 beweisen. Seit Längerem ist bekannt, dass spezifische Einflüsse von O2 auf die Mikrozirkulation dessen Wirksamkeit im Hinblick auf die Gewebeoxygenierung in bestimmten Situationen sogar erheblich verringern können. So führt O2 zu einer arteriolären Konstriktion, die bei einer Vielzahl von Erkrankungen mit einer Einschränkung des regionalen O2-Angebots und hierbei mit einer Verschlechterung der Gewebeoxygenierung vergesellschaftet ist. Der vorliegende Beitrag hat zum Ziel, vor diesem Hintergrund den Stellenwert von O2 als Medikament in der klinischen Medizin kritisch zu bewerten.

Abstract

Oxygen (O2) is the most frequently used pharmaceutical in anesthesiology and intensive care medicine: Every patient receives O2 during surgery or during a stay in the intensive care unit. Hypoxia and hypoxemia of various origins are the most typical indications which are mentioned in the prescribing information of O2: the goal of the administration of O2 is either an increase of arterial O2 partial pressure in order to treat hypoxia, or an increase of arterial O2 content in order to treat hypoxemia. Most of the indications for O2 administration were developed in former times and have seldom been questioned from that time on as the short-term side-effects of O2 are usually considered to be of minor importance. As a consequence only a small number of controlled randomized studies exist, which can demonstrate the efficacy of O2 in terms of evidence-based medicine. However, there is an emerging body of evidence that specific side-effects of O2 result in a deterioration of the microcirculation. The administration of O2 induces arteriolar constriction which will initiate a decline of regional O2 delivery and subsequently a decline of tissue oxygenation. The aim of the manuscript presented is to discuss the significance of O2 as a pharmaceutical in the clinical setting.

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  1. Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum der Johann Wolfgang Goethe Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland

    J. Meier

  2. Klinik für Anästhesiologie, Operative Intensivmedizin und Schmerztherapie, Krankenhaus Nordwest, Frankfurt am Main, Deutschland

    O. Habler

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Meier, J., Habler, O. Rationaler Einsatz von Sauerstoff in Anästhesie und Intensivmedizin. Anaesthesist 60, 292–302 (2011). https://doi.org/10.1007/s00101-011-1888-x

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