Verwendung differenzierter Beatmungsstrategien in der präklinischen Notfallmedizin in der Bundesrepublik Deutschland

Zusammenfassung

Ziel der Studie Die vorliegende Arbeit untersucht den präklinischen Einsatz differenzierter Beatmungsstrategien in Deutschland.

Methodik Onlinebefragung deutscher Notärzte nach Verfügbarkeit moderner Respiratoren, regelhaft verwendeten Beatmungseinstellungen, Monitoring und Zielparametern der Ventilation.

Ergebnisse Die Verfügbarkeit moderner Notfallrespiratoren betrug 95%. Regelhafte Abweichungen von den Leitlinien zur Beatmung wurden von 68% angegeben und betrafen positiven endexspiratorischer Druck (19%), Tidalvolumen (13%), Spitzendruck (3%) Atemfrequenz (2%). 90% verwendeten regelmäßig die Kapnografie. 82% steuerten den inspiratorischen Sauerstoffgehalt anhand der Sauerstoffsättigung. Eine Inverse-Ratio-Ventilation wurde regelmäßig von 9% verwendet.

Schlussfolgerung Abweichungen von leitliniengerechten Beatmungseinstellungen und -Monitoring sind häufig. Die aus der Intensivmedizin stammenden Empfehlungen sollten präklinisch auf Anwendbarkeit evaluiert und ggf. adaptiert werden.

Abstract

Objectives To determine the use of differentiated invasive ventilation strategies in the prehospital setting by German emergency physicians.

Methods Online survey of German emergency physicians on availability of modern respirators, regularly used ventilator settings, monitoring and target parameters of ventilation.

Results 95% had pre-hospital access to differentiated respirators. 68% regularly use non-guideline compliant ventilation settings. Deviations mainly affected positive endexpiratory pressure (19%), tidal volume (13%), peak pressure (3%) and respiratory rate (2%). 90% regularly used capnography, 82% stated to adjust fraction of inspiratory oxygen by peripheral capillary oxygen saturation. Interestingly, inversed ratio ventilation was used by 9% of German emergency physicians.

Conclusion Deviations from guideline recommendations for ventilation strategies are frequent. The recommendations from intensive care medicine should be evaluated preclinically for applicability.

Schlüsselwörter

Beatmung - Atemwegsmanagement - Intubation - Notfallmedizin - Intensivmedizin

Keywords

emergency care - intubation - ventilation - airway management

Publication History

Received: 29 December 2020

Accepted after revision: 02 May 2021

Article published online:
09 July 2021

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