Trachealkanülen-Management bei ICU-acquired Weakness

Das Trachealkanülen-Management bei Patient*innen mit Intensive-Care-Unit-acquired Weakness (ICU-AW) ist anspruchsvoll und erfordert ein komplexes multidisziplinäres Vorgehen. Durch die ICU-AW sind durch muskuläre Schwäche oft Atmung und Schlucken beeinträchtigt, und das Weaning ist prolongiert. Spezialisierte Therapieansätze fördern die Dekanülierung, minimieren das Aspirationsrisiko und unterstützen das Wiedererlangen von Alltagsfunktionen.

Abstract

Tracheostomy management in critically ill patients with intensive care unit-acquired weakness is complex and requires a multidisciplinary approach. ICU-AW often leads to muscular weakness, impairing breathing and swallowing and resulting in prolonged weaning. Specialized therapeutic interventions promote decannulation, minimize the risk of aspiration, and support the recovery of activities of daily living.

Schlüsselwörter

Trachealkanülenmanagement - ICU-Acquired Weakness - prolongiertes Weaning - Aspirationsrisiko

Key Words

Tracheostomy - ICU-acquired weakness - prolonged weaning - aspiration risk

Publication History

Article published online:
03 February 2025

• Literatur

• 1 Appleton RT, Kinsella J, Quasim T. The incidence of intensive care unit-acquired weakness syndromes: A systematic review. J Intensive Care Soc 2015; 16: 126-136
• 2 Jung B, Moury PH, Mahul M. et al. Diaphragmatic dysfunction in patients with ICU-acquired weakness and its impact on extubation failure. Intensive Care Med 2016; 42: 853-861
• 3 Hermans G, Van Den Berghe G. Clinical review: intensive care unit acquired weakness. Crit Care 2015; 19: 274
• 4 Schönhofer B, Geiseler J, Dellweg D. et al. Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V. S2k-Leitlinie „Prolongiertes Weaning“. Pneumologie 2019; 73: 723-814
• 5 Vassilakopoulos T, Petrof BJ. Ventilator-induced diaphragmatic dysfunction. Am J Resp Crit Care Med 2004; 169: 336-341
• 6 Schweizerische Gesellschaft für Dysphagie (SGD). Empfehlungen für ein interprofessionelles Trachealkanülenmanagement (08/2015). Im Internet (Stand 28.02.2024): www.dysphagie-suisse.ch
• 7 Wallace S, Mcgrath B. Laryngeal complications after tracheal intubation and tracheostomy. BJA Education 2021; 21: 250
• 8 Wilhelm W. Praxis der Intensivmedizin. Berlin: Springer; 2013
• 9 Sutt AL, Tronstad O, Barnett AG. et al. Earlier tracheostomy is associated with an earlier return to walking, talking, and eating. Austral Crit Care 2020; 33: 213-218
• 10 De Larminat V, Montravers P, Dureuil B. et al. Alteration in swallowing reflex after extubation in intensive care unit patients. Crit Care Med 1995; 23: 486-490
• 11 Elpern EH, Borkgren Okonek M, Bacon M. et al. Effect of the Passy-Muir tracheostomy speaking valve on pulmonary aspiration in adults. Heart Lung 2000; 29: 287-293
• 12 Dettelbach MA, Gross RD, Mahlmann J. et al. Effect of the Passy‐Muir valve on aspiration in patients with tracheostomy. Head Neck 1995; 17: 297-302
• 13 OʼConnor LR, Morris NR, Paratz J. Physiological and clinical outcomes associated with use of one-way speaking valves on tracheostomised patients: A systematic review. Heart Lung 2019; 48: 356-364
• 14 Stollings JL, Kotfis K, Chanques G. et al. Delirium in critical illness: clinical manifestations, outcomes, and management. Intensive Care Med 2021; 47: 1089-1103
• 15 Schwegler H. Trachealkanülenmanagement – Dekanülierung beginnt auf der Intensivstation. Idstein: Schulz-Kirchner; 2017
• 16 Lee M, Wilson H. Complications of tracheostomy. Shanghai Chest 2021; 5
• 17 Austin JH, Müller NL, Friedman PJ. et al. Glossary of terms for CT of the lungs: recommendations of the Nomenclature Committee of the Fleischner Society. Radiology 1996; 200: 327-331
• 18 Zuercher P, Moret CS, Dziewas R. et al. Dysphagia in the intensive care unit: epidemiology, mechanisms, and clinical management. Crit Care 2019; 23: 103
• 19 Zuercher P, Schenk NV, Moret C. et al. Risk Factors for Dysphagia in ICU Patients After Invasive Mechanical Ventilation. Chest 2020; 158: 1983-1991