Die nichtinvasive Beatmung (NIV) kann effektiv das Typ-II-hyperkapnische Atemversagen
therapieren. Vor allem bei Patienten mit chronisch-obstruktiven oder thorakal-restriktiven
Lungenerkrankungen oder neuromuskulären Erkrankungen liegt der Hyperkapnie eine chronisch
oder akut geschwächte Atemmuskelpumpe zugrunde. Der Beitrag erklärt die relevanten
Befunde sowie Indikation, Einleitung und Verlaufskontrollen der NIV.
Abstract
COPD is the most common reason for hypercapnia. However, it is -by far- not the only
reason. In fact, numerous neuromuscular disorders (not only ALS) as well as restrictive
thoracic disorders do also lead to clinically highly relevant hypercapnia. Early diagnosis
of hypercapnic ventilatory failure usually takes place at nighttime. NIV devices work
with a periodic interplay of alternating IPAP and EPAP which results in a ventilation
of the lungs, thereby elimination CO2 to treat hypercapnic respiratory failure. Firstline
settings for a NIV therapy to treat „stable hypercapnia“ are as follows: Pressure
Support Ventilation Modus, EPAP 5 cmH2O, IPAP 15 cmH2O, Back Up rate 15/Minute. The
overall goal of NIV treatment is a successful reduction in CO2. This can be achieved
by changing the following variables of the ventilator settings: increase in IPAP ±
increase in back up respiratory rate ± use of assisted pressure controlled ventilation
mode (APCV)-
Schlüsselwörter
nichtinvasive Beatmung - Pneumologie - COPD - neuromuskuläre Erkrankungen
Key words
non-invasive ventilation - pneumology - COPD - neuromuscular disorders
