Beatmung bei akuter ventilatorischer Insuffizienz

Zusammenfassung

Eine akute ventilatorische Insuffizienz ist definiert durch eine Hyperkapnie mit respiratorischer Azidose und sekundärer Hypoxämie. Das primäre Ziel einer mechanischen Beatmung ist die Verbesserung der alveolären Ventilation, d. h. Kompensation der ventilatorischen Insuffizienz. Nichtinvasive Beatmung wurde bereits während der letzten großen Polio-Epidemie als Beatmungstherapie angewandt, damals in Form von Negativdruckbeatmung. In den letzten 2 Jahrzehnten hat sie in Form von Positivdruckbeatmung ihren Platz in der Heimbeatmung, aber auch einen zunehmenden Stellenwert in der Therapie der akuten respiratorischen Insuffizienz gewonnen. Hauptindikation ist das hyperkapnische Ventilationsversagen im Rahmen der Exazerbation einer COPD. Die vorliegende Arbeit gibt einen Überblick über die Beatmungstherapie im Allgemeinen sowie die aktuelle Datenlage zur nichtinvasiven Beatmung bei akuter ventilatorischer Insuffizienz. Im Einzelnen werden die verschiedenen Interfaces diskutiert, die Indikationen sowie Kontraindikationen erörtert.

Abstract

Acute ventilatory insufficiency is characterized by hypercapnia, respiratory acidosis and secondary hypoxemia. The primary target of mechanical ventilation is improvement of alveolar ventilation, that means compensation of the ventilatory insufficiency. Noninvasive ventilation started as ventilatory support during the big polio epidemic, at that time in form of negative pressure ventilation. In the last two decades NIV is in form of positive pressure ventilation important for long-term ventilation at home, but there is also growing importance of NIV in the treatment of acute respiratory insufficiency in the intensive care unit. Main indication is the hypercapnic ventilatory failure in acute exacerbation of COPD. This paper will discuss ventilator therapy in general but also the data regarding the role of NIV in the treatment of hypercapnic failure. Specific points like interfaces, indications and contraindications of NIV are addressed.

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