Die schwierige Extubation

Leitthema

Zusammenfassung

Der richtige Zeitpunkt zur Beendigung einer invasiven Beatmung (Extubation) bei Intensivpatienten ist prognostisch entscheidend. Zu vermeiden sind eine zu frühzeitige Extubation mit dem Risiko der Re-Intubation wie auch eine verspätete Extubation mit Verlängerung der Beatmungszeit. Meist gelingt eine Extubation unproblematisch, doch in einigen Fällen kann sie deutlich erschwert oder gar unmöglich sein. Dafür gibt es zwei Hauptgründe: Erstens das Larynxödem (hier sind der Nebenlufttest und die Gabe von Steroiden etablierte diagnostische/therapeutische Maßnahmen, um mögliche laryngeale Komplikationen vor der Extubation zu erkennen und zu behandeln), zweitens die fortbestehende respiratorische Insuffizienz auch nach Behandlung der akuten respiratorischen Insuffizienz, entweder in Form eines Postextubationsversagens oder eines Weaning-Versagens (hier hat die nichtinvasive Beatmung einen zunehmenden Stellenwert). Gegenwärtig entstehen in Deutschland für die komplexen Anforderungen eines prolongierten Weanings spezialisierte und akkreditierte Entwöhnungszentren.

Schlüsselwörter

Larynxödem Nichtinvasive Beatmung Postextubationsversagen Re-Intubation Weaning 

Difficult extubation

Abstract

Optimal timing of extubation following intubation substantially impacts on the prognosis of intensive care unit (ICU) patients whereby both early extubation with the risk of reintubation and delayed extubation with prolongation of mechanical ventilation need to be avoided. In most cases extubation is easy; in some cases, however, extubation may be extremely difficult or even impossible with two major reasons being responsible for this: firstly, laryngeal edema, where the cuff leak test and steroid treatment are well established procedures aimed at diagnosing and treating potential laryngeal complications and secondly, the presence of (chronic) respiratory failure despite sufficient treatment of acute respiratory failure. This can result in post-extubation failure following extubation or weaning failure and noninvasive ventilation has been increasingly used in both scenarios. Currently, specialised weaning centres are being established and certified in Germany aimed at managing the complex tasks for patients with prolonged weaning.

Keywords

Laryngeal edema Noninvasive ventilation Postextubation failure Reintubation Weaning 

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Abt. Pneumologie – Lungenklinik MerheimKliniken der Stadt KölnKölnDeutschland

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