Nicht-invasive respiratorische Unterstützung bei akuter respiratorischer Insuffizienz mit Fokus auf High-Flow-Sauerstofftherapie und nicht-invasive Beatmung

Zusammenfassung

Die akute respiratorische Insuffizienz zählt zu den häufigsten Notfällen in der Notfall- und Intensivmedizin und ist mit einer Mortalität bis zu 50% assoziiert. Pathophysiologisch wird zwischen hypoxämischer, hyperkapnischer und gemischter Form unterschieden. Hypoxämische Insuffizienzen entstehen meist durch Parenchymerkrankungen oder V/Q-Mismatch, hyperkapnische Insuffizienzen spiegeln ein Atempumpversagen wider. Das Monitoring umfasst klinische Beurteilung, Atemfrequenz, Pulsoxymetrie und Blutgasanalyse; Kapnometrie sowie moderne Verfahren wie Impedanztomografie oder Ösophagusdruckmessung können ergänzend eingesetzt werden. Therapeutisch haben sich High-Flow-Sauerstofftherapie (HFOT) und nicht-invasive Beatmung (NIV) etabliert. HFOT verbessert Komfort, Sekretmobilisation und Oxygenierung, während NIV insbesondere bei hyperkapnischer Insuffizienz wirksam ist. Beide Verfahren können Intubationen vermeiden, erfordern jedoch engmaschiges Monitoring und rechtzeitige Eskalation bei Therapieversagen.

Abstract

Acute respiratory insufficiency (ARI) is among the most frequent emergencies in emergency and intensive care medicine and is associated with mortality rates of up to 50%. Pathophysiologically, ARI is classified into hypoxemic, hypercapnic, and mixed forms. Hypoxemic insufficiency typically results from parenchymal lung disease or ventilation–perfusion mismatch, whereas hypercapnic insufficiency reflects pump failure. Monitoring includes clinical assessment, respiratory rate, pulse oximetry, and blood gas analysis; capnometry as well as advanced techniques such as electrical impedance tomography or esophageal pressure measurement may be used as adjuncts. Therapeutically, high-flow oxygen therapy (HFOT) and non-invasive ventilation (NIV) have become established. HFOT improves comfort, secretion clearance, and oxygenation, while NIV is particularly effective in hypercapnic insufficiency. Both modalities can reduce the need for intubation but require close monitoring and timely escalation in case of treatment failure.

Schlüsselwörter

akute respiratorische Insuffizienz - HFOT - NIV

Keywords

acute respiratory insufficiency - HFOT - NIV

Publication History

Received: 12 September 2025

Accepted after revision: 18 December 2025

Article published online:
21 January 2026

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