Respiratorentwöhnung – Welche Verfahren sind geeignet?

Zusammenfassung

Eine Intubation und invasive maschinelle Beatmung können beim akuten respiratorischen Versagen lebensrettend sein. Mit der Dauer der Beatmung steigt allerdings die Rate unerwünschter Komplikationen und eine prolongierte Beatmung ist mit einer erhöhten Morbidität, Mortalität und hohen Kosten assoziiert. Da bis zu 40% der Gesamtbeatmungszeit von Intensivpatienten auf die Beatmungsentwöhnung entfallen, ist eine optimale Entwöhnungsstrategie essenziell. Es gibt verschiedene - teilweise kontrovers diskutierte - Konzepte, die Beatmungsentwöhnung zu erleichtern. Sie umfassen das frühzeitige Überprüfen der Voraussetzung für eine Beatmungsentwöhnung anhand etablierter Kriterien, die Wahl des Beatmungskonzepts und Beatmungsverfahrens sowie den Einsatz von Entwöhnungsprotokollen und automatisierter Beatmungs- und Entwöhnungsverfahren. Der vorliegende Artikel beschreibt den Stellenwert verschiedener (Beatmungs-)Verfahren und Strategien, die bei der Entwöhnung von der Beatmung zum Einsatz kommen.

Abstract

During acute respiratory failure, intubation and invasive mechanical ventilation may be life saving procedures. However, with increasing time on the ventilator, the rate of complications increases and prolonged mechanical ventilation is associated with increased morbidity, mortality and high ICU cost. Since the weaning period accounts for 40% of the overall ventilation period, optimizing weaning is mandatory to shorten mechanical ventilation. Various concepts to facilitate weaning have been proposed and there is an ongoing debate about the most effective methods. These include an early screening of weaning readiness based on established criteria, the choice of the concept of ventilation and ventilator modes, the use of weaning protocols, „closed loop“ automated ventilation and weaning. This article describes the relevance of the different ventilator strategies that are applied during weaning from mechanical ventilation.

Kernaussagen

• Vor dem Hintergrund steigender Zahlen beatmungspflichtiger Patienten muss vorrangiges Ziel sein, eine verzögerte und prolongierte Entwöhnung zu vermeiden.

• Die systematische Evaluierung der Entwöhnungsbereitschaft verkürzt die Beatmungsdauer und erhöht die Patientensicherheit.

• Der Einsatz von Protokollen kann dazu beitragen, die Beatmungs- und Liegedauer signifikant zu verkürzen.

• Phasen der atemmuskulären Be- und Entlastung sind wichtiger Bestandteil des Therapiekonzepts, eine reine kontrollierte Beatmung ist aber selten indiziert assistierte Beatmungsverfahren sollten bevorzugt werden.

• Im Beatmungsgerät implementierte Algorithmen zur automatischen Beatmungsentwöhnung können diese beschleunigen.

• Neue automatisierte Beatmungsverfahren sind vielversprechend, müssen ihren Stellenwert bei der Verhinderung schwieriger Entwöhnung oder während der Entwöhnung von der Beatmung allerdings noch eindeutiger unter Beweis stellen.

Schlüsselwörter:

Beatmungsentwöhnung - Weaning - Weaningstrategien - maschinelle Beatmung

Key words:

Respirator weaning - weaning - weaning strategy - mechanical ventilation

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