Hohe FIO₂ beim Intensivpatienten: Pro und Kontra

Einleitung

Ziel der zusätzlichen Gabe von Sauerstoff und der mechanischen Beatmung ist in der Regel die Sicherstellung und Optimierung der alveolären Ventilation und des pulmonalen Gasaustausches. Diese Maßnahmen sind keine Therapien im engeren Sinne, sie haben lediglich den Zweck, eine vorübergehende Störung der Atmung zu überbrücken bis zur Besserung oder Heilung der zugrunde liegenden Erkrankung. Dabei gilt es zu beachten, dass die mechanische Beatmung selbst, wie nachfolgend kurz dargelegt, zu einer Störung des Gasaustausches führen kann. Mit der Absicht, den gestörten Gasaustausch zu korrigieren wird - oft sogar beim Patienten mit gesunden Lungen - der Anteil an Sauerstoff im inspiratorischen Gasgemisch (FIO₂) über den normalen Wert von 0,21 erhöht. Wie weiter unten diskutiert gibt es Hinweise, dass eine Anhebung des Partialdruckes von Sauerstoff im arteriellen Blut über die normalen Werte (erreicht durch eine Erhöhung von FIO₂) in gewissen Situationen günstig sein kann. Es gilt dabei aber zu beachten, dass solche Maßnahmen auch potenzielle Nebenwirkungen haben können. Ziel dieser kurzen Übersicht ist es, die Veränderung des Gasaustausches bei mechanischer Beatmung, einen möglichen Nutzen und potenzielle Risiken der Anwendung von hoher FIO₂ darzustellen.

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