Nichtinvasive außerklinische Beatmung: Pathophysiologie, Einstellung, Kontrolle

Die nichtinvasive Beatmung (NIV) kann effektiv das Typ-II-hyperkapnische Atemversagen therapieren. Vor allem bei Patienten mit chronisch-obstruktiven oder thorakal-restriktiven Lungenerkrankungen oder neuromuskulären Erkrankungen liegt der Hyperkapnie eine chronisch oder akut geschwächte Atemmuskelpumpe zugrunde. Der Beitrag erklärt die relevanten Befunde sowie Indikation, Einleitung und Verlaufskontrollen der NIV.

Abstract

COPD is the most common reason for hypercapnia. However, it is -by far- not the only reason. In fact, numerous neuromuscular disorders (not only ALS) as well as restrictive thoracic disorders do also lead to clinically highly relevant hypercapnia. Early diagnosis of hypercapnic ventilatory failure usually takes place at nighttime. NIV devices work with a periodic interplay of alternating IPAP and EPAP which results in a ventilation of the lungs, thereby elimination CO2 to treat hypercapnic respiratory failure. Firstline settings for a NIV therapy to treat „stable hypercapnia“ are as follows: Pressure Support Ventilation Modus, EPAP 5 cmH2O, IPAP 15 cmH2O, Back Up rate 15/Minute. The overall goal of NIV treatment is a successful reduction in CO2. This can be achieved by changing the following variables of the ventilator settings: increase in IPAP ± increase in back up respiratory rate ± use of assisted pressure controlled ventilation mode (APCV)-

Schlüsselwörter

nichtinvasive Beatmung - Pneumologie - COPD - neuromuskuläre Erkrankungen

Key words

non-invasive ventilation - pneumology - COPD - neuromuscular disorders

Publication History

Article published online:
05 November 2021

• Literatur

• 1 AWMF online. S3-Leitlinie Nichtinvasive Beatmung als Therapie der akuten respiratorischen Insuffizienz (AWMF Register-Nummer 020 004). Im Internet (Stand 27.07.2021): https://www.awmf.org/leitlinien/detail/ll/020-004.html
• 2 Windisch W, Geiseler J, Simon K. on behalf of the Guideline Commission.. et al. German National Guideline for Treating Chronic Respiratory Failure with Invasive and Non-Invasive Ventilation: Revised Edition 2017 – Part 1. Respiration 2018; 96: 66-97
• 3 Göhl O, Walker DJ, Walterspacher S. et al. [Respiratory Muscle Training: State of the Art]. Pneumologie 2016; 70: 37-48
• 4 Spießhöfer J, Young P, Boentert M. Neuromuskuläre Erkrankungen und Schlaf. Nervenheilkunde 2019; 38: 108-114
• 5 Henke C, Spiesshoefer J, Kabitz HJ. et al. Characteristics of respiratory muscle involvement in myotonic dystrophy type 1. Neuromuscul Disord 2020; 30: 17-27
• 6 Spiesshoefer J, Runte M, Heidbreder A. et al. Sleep-disordered breathing and effects of non-invasive ventilation on objective sleep and nocturnal respiration in patients with myotonic dystrophy type I. Neuromuscul Disord 2019; 29: 302-309
• 7 Spiesshoefer J, Henke C, Kabitz HJ. et al. The nature of respiratory muscle weakness in patients with late-onset Pompe disease. Neuromuscul Disord 2019; 29: 618-627
• 8 Runte M, Spiesshoefer J, Heidbreder A. et al. Sleep-related breathing disorders in facioscapulohumeral dystrophy. Sleep Breath 2019; 23: 899-906
• 9 Henke C, Spiesshoefer J, Kabitz HJ. et al. Respiratory muscle weakness in facioscapulohumeral muscular dystrophy. Muscle Nerve 2019; 60: 679-686
• 10 Spiesshoefer J, Herkenrath S, Henke C. et al. Evaluation of Respiratory Muscle Strength and Diaphragm Ultrasound: Normative Values, Theoretical Considerations, and Practical Recommendations. Respiration 2020; 99: 369-381
• 11 Spiesshoefer J, Henke C, Schwarz S. et al. Zwerchfell-Ultraschall durchführen und interpretieren – Schritt für Schritt. Pneumologie 2019; 73: e4
• 12 Huttmann SE, Windisch W, Storre JH. Techniques for the measurement and monitoring of carbon dioxide in the blood. Ann Am Thorac Soc 2014; 11: 645-652
• 13 Storre JH, Magnet FS, Dreher M. et al. Transcutaneous monitoring as a replacement for arterial PCO(2) monitoring during nocturnal non-invasive ventilation. Respir Med 2011; 105: 143-150
• 14 Ergan B, Oczkowski S, Rochwerg B. et al. European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD. Eur Respir J 2019; 54: 1901003
• 15 Murphy M, Rehal S, Arbane G. et al. Effect of Home Noninvasive Ventilation With Oxygen Therapy vs Oxygen Therapy Alone on Hospital Readmission or Death After an Acute COPD Exacerbation: A Randomized Clinical Trial. JAMA 2017; 317: 2177-2186
• 16 Windisch W, Dellweg D, Geiseler J. et al. Prolonged Weaning from Mechanical Ventilation. Dtsch Arztebl Int 2020; 117: 197-204
• 17 Schönhofer B, Geiseler J, Dellweg D. et al. [Prolonged Weaning – S2k-Guideline Published by the German Respiratory Society]. Pneumologie 2019; 73: 723-814
• 18 Duiverman M, Vonk J, Bladder G. et al. Home initiation of chronic non-invasive ventilation in COPD patients with chronic hypercapnic respiratory failure: a randomised controlled trial. Thorax 2020; 75: 244-252
• 19 Borel JC, Pelletier J, Taleux N. et al. Parameters recorded by software of non-invasive ventilators predict COPD exacerbation: a proof-of-concept study. Thorax 2015; 70: 284-285
• 20 Windisch W, Freidel K, Schucher B. et al. The Severe Respiratory Insufficiency (SRI) Questionnaire: a specific measure of health-related quality of life in patients receiving home mechanical ventilation. Clin Epidemiol 2003; 56: 752-759