Respiratorentwöhnung – Die Atemmuskelpumpe – Bedeutung für die Respiratorentwöhnung

Zusammenfassung

Das Erfassen und die Beurteilung der Funktion der Atemmuskulatur hat eine elementare Bedeutung für die Respiratorentwöhnung beatmeter Patienten. Gleichwohl ist die Messung von Atemmuskelkraft und Ausdauer in der klinischen Routine nicht sehr weit verbreitet. Die Bestimmung des „rapid shallowbreathingindex“ ist eine wertvolle Hilfe zur Einschätzung der Belastung der Atempumpe und zur Vermeidung eines Entwöhnungsversagens. Allerdings ersetzt dieser Parameter in der Adaptation der Beatmungstherapie an die Bedürfnisse und Möglichkeiten, insbesondere bei Patienten mit schwieriger oder prolongierter Entwöhnung, die Messung von Atemmuskelkraft und Ausdauer nicht. Ziel der Beatmungstherapie während der Entwöhnung vom Respirator ist es ein Gleichgewicht zwischen Ent- und Belastung der Atemmuskulatur zu finden. Inwieweit und bei welchen Patienten ein inspiratorisches Muskeltraining die Entwöhnung vom Respirator beschleunigt bleibt Gegenstand weiterer Studien und kann derzeit nicht eindeutig beantwortet werden.

Early weaning and discontinuation of mechanical ventilation can help prevent respiratory muscle dysfunction in critically ill patients. Prolonged mechanical ventilation and failure to use adequate strategies to discontinue mechanical ventilation can even enhance and perpetuate respiratory muscle dysfunction. On the other hand, premature attempts to extubate may result in re-intubation due to respiratory failure and are associated with poor outcomes and high mortality rates of up to 30-50%. Therefore, accurate monitoring of the respiratory muscle function is a valuable tool for the clinician at the bedside to assess to optimal weaning strategy and, ideally, would predict either weaning failure or success. In this review, we briefly summarize the available techniques, measurements and equipment required for the monitoring of respiratory muscle function in the intensive care unit.

Schlüsselwörter:

Atemmuskelpumpe - Atemmuskulatur - Respiratorentwöhnung - rapid shallow breathing index - Beatmungstherapie - Muskeltraining

Keywords:

rapid shallow breathing index - weaning - discontinuation of mechanical ventilation - monitoring of respiratory muscle function

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