Schonende Beatmung in der Neonatologie

Zusammenfassung

Bedingt durch ihre Unreife ist die Lunge eines Frühgeborenen nicht gut auf den postnatal notwendigen lebenserhaltenden Gasaustausch vorbereitet. Hauptprobleme sind lange Diffusionsstrecken, Surfactantmangel, Flüssigkeitsüberladung und inadäquate Kontrolle von freien Radikalen und Entzündugsreaktionen. Dadurch können chronische Schäden entstehen, die man unter dem Begriff bronchopulmonale Dysplasie“ zusammenfasst. Besonders schädlich sind große Tidalvolumina und hohe endinspiratorische Volumina, was bei der Steuerung der mechanischen Beat-mung berücksichtigt werden muss. Dieses Ziel kann durch Verwendung einer höheren Beat-mungsfrequenz oder Akzeptieren von höheren CO₂-Partialdrucken (permissive Hyperkapnie) erreicht werden. Der Nutzen ist jedoch in klinischen Studien noch nicht eindeutig belegt. Hochfrequenzoszillationsbeatmung war jedoch einer optimierten konventionellen Beatmung nicht überlegen. Ebenso konnte für synchronisierte und volumenkontrollierte Beatmung kein langfristig bedeutsamer Nutzen nachgewiesen werden. Vielversprechend ist jedoch die zunehmend verbreitete nicht invasive Beatmung, mit deren Einführung die Häufigkeiten verschiedener Komplikationen rückläufig waren.

Summary

The immaturity of the preterm lung results in suboptimal function for gas exchange. Chiefly, thick diffusion barriers, surfactant deficiency, fluid overload and inadequate defence mechanisms against free radicals and inflammatory activities lead to lung damage. Chronic lung damange is summarized as “broncho-pulmonary dysplasia”. Most deleterious are large tidal volumes and high end-inspiratory volumes, which must be avoided when selecting settings of mechanical ventilation. This goal can be achieved by adopting high ventilatory rates and strategies accepting higher partial pressures of CO₂ (permissive hypercapnia). Benefits and risks, however, have not yet been fully established. High-frequency oscillatory ventilation was not superior to optimized conventional ventilation. Furthermore, synchronized and volume-controlled ventilation have not yet been associated with long-term clinical benefits. Non-invasive ventilation is becoming increasingly popular, and was associated with falling complication rates.

Schlüsselwörter

Lunge - Frühgeborene - bronchopulmonale Dysplasie - mechanische Beatmung - nicht invasive Beatmung

Keywords

Lung - preterm infant - bronchopulmonary dysplasia - mechanical ventilation - non-invasive ventilation

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