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Intensivmedizin up2date 2012; 8(1): 9-22
DOI: 10.1055/s-0030-1257099
Allgemeine Prinzipien der Intensivmedizin

© Georg Thieme Verlag KG Stuttgart · New York

Entwöhnung von der Beatmung

Rolf  Dembinski
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Publication History

Publication Date:
12 January 2012 (online)

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Kernaussagen

  • Die schwierige Entwöhnung von der Beatmung macht ein komplexes intensivmedizinisches Vorgehen erforderlich.

  • Effektivität und Effizienz können mit Entwöhnungsprotokollen deutlich gesteigert werden. Eine individuelle Anpassung solcher Protokolle insbesondere hinsichtlich des Einsatzes der nichtinvasiven Beatmung und der Durchführung der Tracheotomie sind allerdings wichtig.

  • In Zukunft dürften extrakorporale Verfahren zur Entwöhnung für ausgewählte Patienten eine zunehmende Bedeutung erlangen.

Literatur

  • 1 Boles J M, Bion J, Connors A et al. Weaning from mechanical ventilation.  Eur Respir J. 2007;  29 1033-1056
    Google Scholar
  • 2 Gattinoni L, Protti A, Caironi P, Carlesso E. Ventilator-induced lung injury: the anatomical and physiological framework.  Crit Care Med. 2010;  38 S539-S548
    Google Scholar
  • 3 Jaber S, Jung B, Matecki S, Petrof B J. Clinical review: Ventilator-induced diaphragmatic dysfunction – human studies confirm animal model findings!.  Crit Care. 2011;  15 206
    Google Scholar
  • 4 Rumbak M J, Newton M, Truncale T, Schwartz S W, Adams J W, Hazard P B. A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients.  Crit Care Med. 2004;  32 1689-1694
    Google Scholar
  • 5 Tadie J M, Behm E, Lecuyer L et al. Post-intubation laryngeal injuries and extubation failure: a fiberoptic endoscopic study.  Intensive Care Medicine. 2010;  36 991-998
    Google Scholar
  • 6 Reid W D, Huang J, Bryson S, Walker D C, Belcastro A N. Diaphragm injury and myofibrillar structure induced by resistive loading.  J Appl Physiol. 1994;  76 176-184
    Google Scholar
  • 7 Laghi F, D'Alfonso N, Tobin M J. Pattern of recovery from diaphragmatic fatigue over 24 hours.  J Appl Physiol. 1995;  79 539-546
    Google Scholar
  • 8 Boulain T. Unplanned extubations in the adult intensive care unit: a prospective multicenter study. Association des Reanimateurs du Centre-Ouest.  Am J Respir Crit Care Med. 1998;  157 1131-1137
    Google Scholar
  • 9 Esteban A, Frutos-Vivar F et al. Noninvasive positive-pressure ventilation for respiratory failure after extubation.  N Engl J Med. 2004;  350 2452-2460
    Google Scholar
  • 10 Girard T D, Kress J P, Fuchs B D et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial.  Lancet. 2008;  371 126-134
    Google Scholar
  • 11 Kress J P, Pohlman A S, O'Connor M F, Hall J B. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation.  N Engl J Med. 2000;  342 1471-1477
    Google Scholar
  • 12 Strom T, Martinussen T, Toft P. A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial.  Lancet. 2010;  375 475-480
    Google Scholar
  • 13 Esteban A, Alia I, Gordo F et al. Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. The Spanish Lung Failure Collaborative Group.  Am J Respir Crit Care Med. 1997;  156 459-465
    Google Scholar
  • 14 Ezingeard E, Diconne E, Guyomarch S et al. Weaning from mechanical ventilation with pressure support in patients failing a T-tube trial of spontaneous breathing.  Intensive Care Medicine. 2006;  32 165-169
    Google Scholar
  • 15 Marini J J. Weaning from mechanical ventilation.  N Engl J Med. 1991;  324 1496-1498
    Google Scholar
  • 16 Durbin C G. Tracheostomy: why, when, and how?.  Respir Care. 2010;  55 1056-1068
    Google Scholar
  • 17 Griffiths J, Barber V S, Morgan L, Young J D. Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation.  BMJ. 2005;  330 1243
    Google Scholar
  • 18 Bickenbach J, Fries M, Offermanns V et al. Impact of early vs. late tracheostomy on weaning: a retrospective analysis.  Minerva Anestesiol. 2011;  77 1176-1183
    Google Scholar
  • 19 Tobin M J, Jubran A. Variable performance of weaning-predictor tests: role of Bayes' theorem and spectrum and test-referral bias.  Intensive Care Medicine. 2006;  32 2002-2012
    Google Scholar
  • 20 Blackwood B, Alderdice F, Burns K, Cardwell C, Lavery G, O'Halloran P. Use of weaning protocols for reducing duration of mechanical ventilation in critically ill adult patients: Cochrane systematic review and meta-analysis.  BMJ. 2011;  342 c7237
    Google Scholar
  • 21 Krishnan J A, Moore D, Robeson C, Rand C S, Fessler H E. A prospective, controlled trial of a protocol-based strategy to discontinue mechanical ventilation.  Am J Respir Crit Care Med. 2004;  169 673-678
    Google Scholar
  • 22 Lellouche F, Mancebo J, Jolliet P et al. A multicenter randomized trial of computer-driven protocolized weaning from mechanical ventilation.  Am J Respir Crit Care Med. 2006;  174 894-900
    Google Scholar
  • 23 Bein T, Wittmann S, Philipp A, Nerlich M, Kuehnel T, Schlitt H J. Successful extubation of an „unweanable“ patient with severe ankylosing spondylitis (Bechterew's disease) using a pumpless extracorporeal lung assist.  Intensive Care Medicine. 2008;  34 2313-2314
    Google Scholar
  • 24 Bombino M, Patroniti N, Foti G, Isgro S, Grasselli G, Pesenti A. Bronchopleural fistulae and pulmonary ossification in posttraumatic acute respiratory distress syndrome: successful treatment with extracorporeal support.  ASAIO J. 2011;  57 336-340
    Google Scholar

Priv.-Doz. Dr. med. Rolf Dembinski

Abteilung für Operative Intensivmedizin und Intermediate Care
Universitätsklinikum der RWTH-Aachen

Pauwelsstraße 30
52074 Aachen

Phone: 0241 80-80444

Fax: 0241 80-3380444

Email: rdembinski@ukaachen.de