Adipositas und Beatmung

Zusammenfassung

Patienten mit Übergewicht weisen bezüglich ihrer Atemmechanik und des daraus folgenden Gasaustausches einige Besonderheiten auf. Dazu gehören die hohe Neigung zu Atelektasen mit Ausbildung eines intrapulmonalen Shunts, die erniedrigte funktionelle Residualkapazität und die besondere Neigung zu Bronchusobstruktion. Bei der maschinellen Beatmung von Patienten mit Adipositas und akutem Lungenversagen sind daher die Einstellung eines optimalen PEEP und die Reduktion von Atelektasen durch Lagerungs-und Rekrutierungsmanöver von besonderer Bedeutung. Gerade weil die Aspekte lungenschonender Beatmung für Adipöse wenig untersucht sind, sollte eine individuelle Einstellung der Beatmungsparameter vorgenommen werden.

Summary

Obese patients are characterized by altered respiratory mechanics frequently resulting in impairments of gas exchange. These patients present with obstructive lung disease, atelectasis, a reduced functional residual capacity and consecutively intrapulmonary right-toleft shunt. Moreover, obese patients are prone to develop rapid small airway collapse and hypoxemia. During mechanical ventilation application of adequate levels of positive end-expiratory pressure is essential to provide both, improved arterial oxygenation and avoidance of end-expiratory alveolar collapse.

Schlüsselwörter

Adipositas - lungenschonende maschinelle Beatmung - Atelektasen - Rekrutierungsmanöver - akutes Lungenversagen

Keywords

Obesity - lung protective mechanical ventilation - atelectasis - recruitment maneuver - acute lung injury

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