Subscribe to RSS
DOI: 10.1055/s-0030-1257099
© Georg Thieme Verlag KG Stuttgart · New York
Entwöhnung von der Beatmung
Publication History
Publication Date:
12 January 2012 (online)

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
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 15
Marini J J.
Weaning from mechanical ventilation.
N Engl J Med.
1991;
324
1496-1498
MissingFormLabel
- 16
Durbin C G.
Tracheostomy: why, when, and how?.
Respir Care.
2010;
55
1056-1068
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
- 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
MissingFormLabel
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