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Hierf\u00fcr werden Fl\u00fcssigkeit und vasoaktive Substanzen verabreicht. Aktuelle Leitlinien empfehlen Noradrenalin als prim\u00e4re vasoaktive Substanz. Bei hohem Noradrenalinbedarf wird die zus\u00e4tzliche Verwendung nichtadrenerger Vasopressoren empfohlen. Zudem gibt es Evidenz, dass ein fr\u00fchzeitiger Einsatz komplement\u00e4rer vasoaktiver Substanzen von Vorteil sein kann. Ein solches Regime, im Sinne eines Breitspektrumvasopressorkonzepts, erscheint auch aus pathophysiologischer Perspektive schl\u00fcssig. Dar\u00fcber hinaus legen Post-hoc-Analysen von Studien mit Vasopressin oder Angiotensin\u00a0II nahe, dass spezifische Subph\u00e4notypen besonders von einzelnen vasoaktiven Substanzen profitieren k\u00f6nnten. Die adjunktive Therapie mit Hydrokortison und Fludrokortison kann das Ansprechen auf Vasopressoren verbessern und die Mortalit\u00e4t senken. Bei kardialer Dysfunktion wird prim\u00e4r ein Therapieversuch mit Dobutamin oder eine Umstellung von Noradrenalin auf Adrenalin empfohlen. Zur Verst\u00e4rkung der inodilatatorischen Effekte k\u00f6nnen Milrinon oder Levosimendan f\u00fcr manche Patient:innen eine zus\u00e4tzliche Therapieoptionen darstellen. Kurzwirksame \u03b2\u2011Blocker sind zwar nicht Teil der Standardtherapie im septischen Schock, k\u00f6nnen aber in Einzelf\u00e4llen bei inad\u00e4quat hoher Sinustachykardie oder atrialen Tachyarrhythmien zur h\u00e4modynamischen Verbesserungen beitragen. Basierend auf pathophysiologischen \u00dcberlegungen und der derzeit verf\u00fcgbaren Evidenz kann der gezielte Einsatz spezifischer vasoaktiver Substanzen bei bestimmten Subph\u00e4notypen gerechtfertigt sein. So k\u00f6nnte auch eine initiale Breitspektrumvasopressortherapie unter Ber\u00fccksichtigung von Biomarkern wie Renin und Patient:innenmerkmalen gefolgt von einer gezielten Deeskalation ein vielversprechender Ansatz sein. Die Effektivit\u00e4t dieser Strategien gilt es jedoch noch in randomisierten kontrollierte Studien zu untersuchen.<\/jats:p>","DOI":"10.1007\/s00063-025-01272-x","type":"journal-article","created":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T14:49:30Z","timestamp":1745506170000},"page":"369-378","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Vasoaktive Substanzen im septischen Schock\u00a0\u2013 individualisierte Strategien","Vasoactive agents in septic shock\u2014individualized strategies"],"prefix":"10.1007","volume":"120","author":[{"given":"Georg Franz","family":"Lehner","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timo","family":"Mayerh\u00f6fer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabian","family":"Perschinka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernhard","family":"Benda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Joannidis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,4,24]]},"reference":[{"issue":"6","key":"1272_CR1","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1056\/NEJMoa2212663","volume":"388","author":"L National Heart","year":"2023","unstructured":"National Heart\u00a0L, Blood Institute\u00a0P, Early Treatment of Acute Lung Injury Clinical Trials N, Shapiro\u00a0NI, Douglas\u00a0IS, Brower\u00a0RG et\u00a0al (2023) Early restrictive or liberal fluid management for sepsis-induced hypotension. 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