Respiratorentwöhnung – Definition und klinischer Kontext aus Sicht der Anästhesie

Abstract

Unabhängig von der Auswahl des Beatmungsverfahrens ist vor allem die rasche Beendigung der invasiven Beatmung wichtig für die Beatmungsentwöhnung. Beatmungsassoziierte Komplikationen müssen frühzeitig erkannt und behandelt werden. Es ist daher wichtig, die entsprechenden Pathomechanismen zu kennen, da sie entscheidenden Einfluß auf den Weaningprozess nehmen.

Um eine ganzheitliche Behandlungvor allem der Patienten im prolongierten Weaning zu ermöglichen, scheint eine enge intensivmedizinsicher Anbindung innerhalb spezialisierter Einheiten unabdingbar.

Independent from the mode of mechanical ventilation, particularly a quick termination of mechanical ventilation is essential for the weaning progress. Respirator-associated complications need to be early detected and treated. Thus it is important to know correspondent pathomechanisms as they have a crucial influence on the weaning process.

To facilitate a holistic treatment approach for patients in prolonged weaning, a tight junction of intensive care within specialized units seems mandatory.

Kernaussagen

• Für die Beatmungstherapie muss die zugrundeliegende Ursache bekannt sein.

• Mit der Beatmungsentwöhnung sollte so früh wie möglich begonnen werden.

• Durch invasive Beatmung auftretende Komplikationen können den Weaningprozess verzögern und haben Einfluss auf das Patientenoutcome.

• Der Balanceakt im Weaning liegt daher in dem optimalen Maß an Förderung der Spontanatmungsaktivität und maschineller Unterstützung zur Entlastung der Zwerchfellmuskulatur.

• Überschreitet die notwendige Atemarbeit die Leistungskapazität der Atemmuskulatur, wird sich der Patient erschöpfen und erneut eine respiratorische Insuffizienz entwickeln.

• Eine Zertifizierung der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) soll dazu beitragen, spezialisierte Zentren zu definieren, in denen insbesondere Patienten im prolongierten Weaning behandelt werden.

• Prolongiertes Weaning erfordert Kompetenzen, Strukturen und Qualitätssicherung in der Intensivmedizin.

Schlüsselwörter:

Weaning - Respiratorentwöhnung - invasive Beatmung - beatmungsassoziierte Komplikationen Weaningprotokoll

Keywords:

weaning - mechanical ventilation - respirator-associated complications,

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