Positionspapier zu Ursachen und Diagnostik der Beatmungsabhängigkeit sowie zu praktischer Durchführung und Abrechnung des Weaning-Prozesses

J. Geiseler; M. Westhoff; D. Dellweg; T. Voshaar; M. Hetzel; M. Pfeifer

doi:10.1055/a-1039-7143

Pneumologie 2019; 73(12): 716-722
DOI: 10.1055/a-1039-7143

Positionspaper der DGP und des VPK

Positionspapier zu Ursachen und Diagnostik der Beatmungsabhängigkeit sowie zu praktischer Durchführung und Abrechnung des Weaning-Prozesses

Erstellt von der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin (DGP) in Zusammenarbeit mit dem Verband pneumologischer Kliniken (VPK)Statement on Causes and Diagnostics of Ventilation Dependency as well as Implementation and Invoicing of the Weaning ProcessCompiled by the German Respiratory Society (DGP) and the Association of Pneumological Clinics (VPK)

J. Geiseler

¹Klinikum Vest, Medizinische Klinik IV, Pneumologie, Beatmungs- und Schlafmedizin, Marl

,

M. Westhoff

²Lungenklinik Hemer, Hemer

,

D. Dellweg

³Fachkrankenhaus Kloster Grafschaft GmbH, Abteilung für Pneumologie II, Schmallenberg

,

T. Voshaar

⁴Stiftung Krankenhaus Bethanien für die Grafschaft Moers, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Moers

,

M. Hetzel

⁵Klinik für Pneumologie, Internistische Intensivmedizin, Beatmungsmedizin und Allgemeine Innere Medizin, Krankenhaus vom Roten Kreuz Bad Cannstatt GmbH, Stuttgart

,

M. Pfeifer

⁶Zentrum für Pneumologie, Klinik Donaustauf, Donaustauf

Literatur
1 Girard TD, Alhazzani W, Kress JP. et al. An Official American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline: Liberation from Mechanical Ventilation in Critically Ill Adults. Rehabilitation Protocols, Ventilator Liberation Protocols, and Cuff Leak Tests. Am J Respir Crit Care Med 2017; 195: 120-133
2 Roussos CS, Macklem PT. Diaphragmatic fatigue in man. J Appl Physiol Respir Environ Exerc Physiol 1977; 43: 189-197
3 Purro A, Appendini L, De Gaetano A. et al. Physiologic determinants of ventilator dependence in long-term mechanically ventilated patients. Am J Respir Crit Care Med 2000; 161: 1115-1123
4 Vassilakopoulos T, Zakynthinos S, Roussos C. Respiratory muscles and weaning failure. Eur Respir J 1996; 9: 2383-2400
5 Dres M, Dube BP, Mayaux J. et al. Coexistence and Impact of Limb Muscle and Diaphragm Weakness at Time of Liberation from Mechanical Ventilation in Medical Intensive Care Unit Patients. Am J Respir Crit Care Med 2017; 195: 57-66
6 Levine S, Nguyen T, Taylor N. et al. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med 2008; 358: 1327-1335
7 Futier E, Constantin JM, Combaret L. et al. Pressure support ventilation attenuates ventilator-induced protein modifications in the diaphragm. Crit Care 2008; 12: R116
8 Schonhofer B, Geiseler J, Dellweg D. et al. S2k-Guideline “Prolonged Weaning”. Pneumologie 2015; 69: 595-607
9 Perren A, Brochard L. Managing the apparent and hidden difficulties of weaning from mechanical ventilation. Intensive Care Med 2013; 39: 1885-1895
10 Dellweg D, Barchfeld T, Haidl P. et al. Tracheostomy decannulation: implication on respiratory mechanics. Head Neck 2007; 29: 1121-1127
11 Dellweg D, Haidl P, Siemon K. et al. Impact of breathing pattern on work of breathing in healthy subjects and patients with COPD. Respir Physiol Neurobiol 2008; 161: 197-200
12 Supinski GS, Westgate P, Callahan LA. Correlation of maximal inspiratory pressure to transdiaphragmatic twitch pressure in intensive care unit patients. Crit Care 2016; 20: 77
13 Carlucci A, Ceriana P, Prinianakis G. et al. Determinants of weaning success in patients with prolonged mechanical ventilation. Crit Care 2009; 13: R97
14 Dube BP, Dres M, Mayaux J. et al. Ultrasound evaluation of diaphragm function in mechanically ventilated patients: comparison to phrenic stimulation and prognostic implications. Thorax 2017; 72: 811-818
15 Llamas-Alvarez AM, Tenza-Lozano EM, Latour-Perez J. Diaphragm and Lung Ultrasound to Predict Weaning Outcome: Systematic Review and Meta-Analysis. Chest 2017; 152: 1140-1150
16 Boussuges A, Gole Y, Blanc P. Diaphragmatic motion studied by m-mode ultrasonography: methods, reproducibility, and normal values. Chest 2009; 135: 391-400
17 Dhungana A, Khilnani G, Hadda V. et al. Reproducibility of diaphragm thickness measurements by ultrasonography in patients on mechanical ventilation. World J Crit Care Med 2017; 6: 185-189
18 Kim WY, Suh HJ, Hong SB. et al. Diaphragm dysfunction assessed by ultrasonography: influence on weaning from mechanical ventilation. Crit Care Med 2011; 39: 2627-2630
19 Goligher EC, Dres M, Fan E. et al. Mechanical Ventilation-induced Diaphragm Atrophy Strongly Impacts Clinical Outcomes. Am J Respir Crit Care Med 2018; 197: 204-213
20 Vivier E, Muller M, Putegnat JB. et al. Inability of Diaphragm Ultrasound to Predict Extubation Failure: A Multicenter Study. Chest 2019; 155: 1131-1139
21 Rosenthal VD, Maki DG, Mehta Y. et al. International Nosocomial Infection Control Consortium (INICC) report, data summary of 43 countries for 2007–2012. Device-associated module. Am J Infect Control 2014; 42: 942-956
22 Cook DJ, Walter SD, Cook RJ. et al. Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 1998; 129: 433-440
23 Melsen WG, Rovers MM, Koeman M. et al. Estimating the attributable mortality of ventilator-associated pneumonia from randomized prevention studies. Crit Care Med 2011; 39: 2736-2742
24 Nguile-Makao M, Zahar JR, Francais A. et al. Attributable mortality of ventilator-associated pneumonia: respective impact of main characteristics at ICU admission and VAP onset using conditional logistic regression and multi-state models. Intensive Care Med 2010; 36: 781-789
25 Kress JP, Pohlman AS, OʼConnor MF. et al. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000; 342: 1471-1477
26 Esteban A, Frutos F, Tobin MJ. et al. A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group. N Engl J Med 1995; 332: 345-350
27 Vitacca M, Vianello A, Colombo D. et al. Comparison of two methods for weaning patients with chronic obstructive pulmonary disease requiring mechanical ventilation for more than 15 days. Am J Respir Crit Care Med 2001; 164: 225-230
28 Boles JM, Bion J, Connors A. et al. Weaning from mechanical ventilation. Eur Respir J 2007; 29: 1033-1056
29 Fichtner F, Moerer O, Laudi S. et al. Mechanical Ventilation and Extracorporeal Membrane Oxygena tion in Acute Respiratory Insufficiency. Dtsch Arztebl Int 2018; 115: 840-847
30 Chatburn RL, Deem S. Respiratory controversies in the critical care setting. Should weaning protocols be used with all patients who receive mechanical ventilation?. Respir Care 2007; 52: 609-619; discussion 19–21
31 Barchfeld T, Dellweg D, Bockling S. et al. Weaning from long-term mechanical ventilation: data of a single weaning center from 2007 to 2011. Dtsch Med Wochenschr 2014; 139: 527-533
32 Osadnik CR, Tee VS, Carson-Chahhoud KV. et al. Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2017; 7: CD004104
33 Antonelli M, Conti G, Rocco M. et al. A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure. N Engl J Med 1998; 339: 429-435
34 Guerin C, Girard R, Chemorin C. et al. Facial mask noninvasive mechanical ventilation reduces the incidence of nosocomial pneumonia. A prospective epidemiological survey from a single ICU. Intensive Care Med 1997; 23: 1024-1032
35 Hess DR. Noninvasive positive-pressure ventilation and ventilator-associated pneumonia. Respir Care 2005; 50: 924-929; discussion 9–31
36 Schonhofer B, Kuhlen R, Neumann P. et al. Clinical practice guideline: non-invasive mechanical ventilation as treatment of acute respiratory failure. Dtsch Arztebl Int 2008; 105: 424-433
37 Ferrer M, Valencia M, Nicolas JM. 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
38 Ornico SR, Lobo SM, Sanches HS. et al. Noninvasive ventilation immediately after extubation improves weaning outcome after acute respiratory failure: a randomized controlled trial. Crit Care 2013; 17: R39
39 Kramer N, Meyer TJ, Meharg J. et al. Randomized, prospective trial of noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med 1995; 151: 1799-1806
40 Plant PK, Owen JL, Elliott MW. Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial. Lancet 2000; 355: 1931-1935