Invasive Beatmung

Zusammenfassung

Auf dem Gebiet der Beatmungsmedizin hat sich den letzten Jahren eine Paradigmenwechsel vollzogen. Insbesondere die wissenschaftlichen und klinischen Erkenntnisse, dass aggressive Beatmung per se eine weitere Schädigung der Lunge bewirken kann, haben zu dem Konzept der protektiven Beatmung geführt. Alle dazugehörigen Maßnahmen sind darauf ausgerichtet, eine möglichst schonende Beatmung durchzuführen. Diese Techniken wie die Anwendung von kleinen Atemzugvolumina oder die Applikation eines höheren positiven endexspiratorischen Drucks (PEEP) sowie frühzeitige Spontanatmung sind inzwischen hinreichend wissenschaftlich überprüft und klinisch etabliert. Die Beatmung von Patienten mit einer akuten Schädigung der Lunge ist eine notwendige, aber invasive therapeutische Maßnahme, die für jeden Patienten ein strukturiertes und klares Beatmungskonzept erfordert.

Summary

In the field of artificial ventilation a paradigm shift occurred within the last years. In particular the scientific and clinical cognitions that aggressive ventilation itself may cause a progressive lung damage yielded the concept of protective-ventilation. Protective-ventilation includes a variety of strategies aiming for limitation of ventilator associated lung damage. These strategies such as the application of small tidal volumes, use of higher PEEP as well as early switch to the spontaneous ventilation mode are meanwhile scientifically proven and clinically established. Artificial ventilation of patients with acute respiratory distress is a mandatory, but invasive therapy that requires for each individual patient a structured and definite ventilation strategy.

invasive Beatmung - ARDS - protektive Beatmung - Hoch-Frequenz-Oszillations-Ventilation

invasive ventilation - ARDS - protective ventilation - high-frequency-oscillation-ventilation

Literatur

• 1 The 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
• 2 Amato M B, Barbas C S, Medeiros D M. et al . Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome.  N Engl J Med. 1998;  338 347-354
• 3 Andersen F A, Guttormsen A B, Flaatten H K. High frequency oscillatory ventilation in adult patients with acute respiratory distress syndrome - a retrospective study.  Acta Anaesthesiol Scand. 2002;  46 1082-1088
• 4 Arnold J H, Hanson J H, Toro-Figuero L O. et al . Prospective, randomized comparison of high-frequency oscillatory ventilation and conventional mechanical ventilation in pediatric respiratory failure.  Crit Care Med. 1994;  22 1530-1539
• 5 Bein T, Kuhr L P, Bele S. et al . Lung recruitment maneuver in patients with cerebral injury: effects on intracranial pressure and cerebral metabolism.  Intensive Care Med. 2002;  28 554-558
• 6 Bollen C W, van Well G T, Sherry T. et al . High frequency oscillatory ventilation compared with conventional mechanical ventilation in adult respiratory distress syndrome: a randomized controlled trial [ISRCTN24242669].  Crit Care. 2005;  9 R430-439
• 7 Brower R G, Morris A, MacIntyre N. et al . Effects of recruitment maneuvers in patients with acute lung injury and acute respiratory distress syndrome ventilated with high positive end-expiratory pressure.  Crit Care Med. 2003;  31 2592-2597
• 8 Cartotto R, Cooper A B, Esmond J R. et al . Early clinical experience with high-frequency oscillatory ventilation for ARDS in adult burn patients.  J Burn Care Rehabil. 2001;  22 325-333
• 9 Chang H K. Mechanisms of gas transport during ventilation by high-frequency oscillation.  J Appl Physiol. 1984;  56 553-563
• 10 Chastre J, Fagon J Y. Ventilator-associated pneumonia.  Am J Respir Crit Care Med. 2002;  165 867-903
• 11 Claridge J A, Hostetter R G, Lowson S M. et al . High-frequency oscillatory ventilation can be effective as rescue therapy for refractory acute lung dysfunction.  Am Surg. 1999;  65 1092-1096
• 12 Cook D J, Walter S D, Cook R J. et al . Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients.  Ann Intern Med. 1998;  129 433-440
• 13 David M, Weiler N, Heinrichs W. et al . High-frequency oscillatory ventilation in adult acute respiratory distress syndrome.  Intensive Care Med. 2003;  29 1656-1665
• 14 Derdak S, Mehta S, Stewart T E. et al . High-frequency oscillatory ventilation for acute respiratory distress syndrome in adults: a randomized, controlled trial.  Am J Respir Crit Care Med. 2002;  166 801-808
• 15 Ferrer M, Valencia M, Nicolas J M. et al . Early noninvasive ventilation averts extubation failure in patients at risk: a randomized trial.  Am J Respir Crit Care Med. 2006;  173 164-170
• 16 Fort P, Farmer C, Westerman J. et al . High-frequency oscillatory ventilation for adult respiratory distress syndrome - a pilot study.  Crit Care Med. 1997;  25 937-947
• 17 Grasso S, Mascia L, Del Turco M. et al . Effects of recruiting maneuvers in patients with acute respiratory distress syndrome ventilated with protective ventilatory strategy.  Anesthesiology. 2002;  96 795-802
• 18 Hickling K G. Low volume ventilation with permissive hypercapnia in the Adult Respiratory Distress Syndrome.  Clin Intensive Care. 1992;  3 67-78
• 19 Imai Y, Nakagawa S, Ito Y. et al . Comparison of lung protection strategies using conventional and high-frequency oscillatory ventilation.  J Appl Physiol. 2001;  91 1836-1844
• 20 Kress J P, Pohlman A S, O’Connor M F. et al . Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation.  N Engl J Med. 2000;  342 1471-1477
• 21 Lachmann B. Open up the lung and keep the lung open.  Intensive Care Med. 1992;  18 319-321
• 22 Mehta S, Lapinsky S E, Hallett D C. et al . Prospective trial of high-frequency oscillation in adults with acute respiratory distress syndrome.  Crit Care Med. 2001;  29 1360-1369
• 23 Rotta A T, Gunnarsson B, Fuhrman B P. et al . Comparison of lung protective ventilation strategies in a rabbit model of acute lung injury.  Crit Care Med. 2001;  29 2176-2184
• 24 Tobin M J. Advances in mechanical ventilation.  N Engl J Med. 2001;  344 1986-1996
• 25 Villar J, Kacmarek R M, Perez-Mendez L. et al . A high positive end-expiratory pressure, low tidal volume ventilatory strategy improves outcome in persistent acute respiratory distress syndrome: a randomized, controlled trial.  Crit Care Med. 2006;  34 1311-1318