Was hat sich seit Publikation der S3-Leitlinie „Invasive Beatmung und Einsatz extrakorporaler Verfahren“ getan?

Zusammenfassung

Ende 2017 erschien die erste Deutsche S3-Leitlinie zur invasiven Beatmung und dem Einsatz extrakorporaler Verfahren bei akuter respiratorischer Insuffizienz. Der vorliegende Artikel beschreibt die wesentlichen, seit Erstellung der Leitlinie etablierten Neuerungen. Im Fokus steht die neue Evidenz zum Einsatz extrakorporaler Lungenersatzverfahren, die Phänotypisierung des ARDS, der Stellenwert der Muskelrelaxierung sowie die nicht-invasive Beatmung und High-Flow-Sauerstoff-Therapie.

Abstract

In 2017 the German Clinical Guideline for Treating Acute Respiratory Insufficiency with Invasive Ventilation and Extracorporeal Membrane Oxygenation: Evidence-Based Recommendations were released. This article highlights emerging data and new concepts which were introduced since 2017. Among others it summarizes the current progress made in evidence-based recommendations of mechanical ventilation and extracorporeal membrane oxygenation (ECMO). In detail, the new evidence for treating severe ARDS with ECMO, phenotyping of ARDS, early neuromuscular blockade and the application of non-invasive ventilation and high-flow oxygen therapy are discussed.

• Literatur

• 1 Fichtner F, Moerer O, Laudi S. et al. Mechanical Ventilation and Extracorporeal Membrane Oxygena tion in Acute Respiratory Insufficiency. Dtsch Arztebl Int 2018; 115: 840-847
• 2 Fichtner F, Moerer O, Weber-Carstens S. et al. Clinical Guideline for Treating Acute Respiratory Insufficiency with Invasive Ventilation and Extracorporeal Membrane Oxygenation: Evidence-Based Recommendations for Choosing Modes and Setting Parameters of Mechanical Ventilation. Respiration 2019; 98: 357-372
• 3 Combes A, Hajage D, Capellier G. et al. Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome. N Engl J Med 2018; 378: 1965-1975
• 4 Peek GJ, Mugford M, Tiruvoipati R. et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 2009; 374: 1351-1363
• 5 Brower RG, Matthay MA. et al., Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000; 342: 1301-1308
• 6 Goligher EC, Tomlinson G, Hajage D. et al. Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome and Posterior Probability of Mortality Benefit in a Post Hoc Bayesian Analysis of a Randomized Clinical Trial. JAMA 2018; 320: 2251-2259
• 7 Aoyama H, Uchida K, Aoyama K. et al. Assessment of Therapeutic Interventions and Lung Protective Ventilation in Patients With Moderate to Severe Acute Respiratory Distress Syndrome: A Systematic Review and Network Meta-analysis. JAMA Netw Open 2019; 2: e198116
• 8 Karagiannidis C, Brodie D, Strassmann S. et al. Extracorporeal membrane oxygenation: evolving epidemiology and mortality. Intensive Care Med 2016; 42: 889-896
• 9 Papazian L, Forel JM, Gacouin A. et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med 2010; 363: 1107-1116
• 10 Moss M, Huang DT, Brower RG. et al., National Heart L, Blood Institute PCTN. Early Neuromuscular Blockade in the Acute Respiratory Distress Syndrome. N Engl J Med 2019; 380: 1997-2008
• 11 Calfee CS, Delucchi K, Parsons PE. et al. Subphenotypes in acute respiratory distress syndrome: latent class analysis of data from two randomised controlled trials. Lancet Respir Med 2014; 2: 611-620
• 12 Calfee CS, Delucchi KL, Sinha P. et al. Acute respiratory distress syndrome subphenotypes and differential response to simvastatin: secondary analysis of a randomised controlled trial. Lancet Respir Med 2018; 6: 691-698
• 13 McAuley DF, Laffey JG, OʼKane CM. et al. Simvastatin in the acute respiratory distress syndrome. N Engl J Med 2014; 371: 1695-1703
• 14 Lemiale V, Mokart D, Resche-Rigon M. et al. Effect of Noninvasive Ventilation vs Oxygen Therapy on Mortality Among Immunocompromised Patients With Acute Respiratory Failure: A Randomized Clinical Trial. JAMA 2015; 314: 1711-1719
• 15 Azoulay E, Lemiale V, Mokart D. et al. Effect of High-Flow Nasal Oxygen vs Standard Oxygen on 28-Day Mortality in Immunocompromised Patients With Acute Respiratory Failure: The HIGH Randomized Clinical Trial. JAMA 2018; 320: 2099-2107
• 16 Bellani G, Laffey JG, Pham T. et al. Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome. Insights from the LUNG SAFE Study. Am J Respir Crit Care Med 2017; 195: 67-77
• 17 Brochard L, Slutsky A, Pesenti A. Mechanical Ventilation to Minimize Progression of Lung Injury in Acute Respiratory Failure. Am J Respir Crit Care Med 2017; 195: 438-442