Abstract
Noninvasive mechanical ventilation (NIV) is used to treat chronic ventilatory insufficiency (CVI) and acute respiratory failure (ARF). Various diseases cause CVI and here home mechanical ventilation (HMV) has become an important treatment option. Clinical improvements due to HMV have been shown for CVI due to restrictive disorders of the rib cage like kyphoscoliosis or posttuberculosis sequelae, with an increase of quality of life, walking distance and a decrease in pulmonary hypertension. Conversely, HMV in patients with COPD is controversial and should be limited to patients with severe hypercapnia, using effective inspiratory pressures which significantly reduce work of breathing.
NIV is an important treatment of ARF. Based on the evidence, NIV should be used to prevent intubation in patients with hypercapnic ARF due to COPD exacerbations or acute cardiogenic pulmonary edema, and in immunocompromised patients, as well as to facilitate extubation in patients with COPD who require initial intubation. Weaker evidence supports consideration of NIV in hypoxemic ARF due to severe pneumonia, acute lung injury, or acute respiratory distress syndrome.
Zusammenfassung
Nichtinvasive Beatmung (NIV) kommt bei chronisch ventilatorischer Insuffizienz (CVI) und akut respiratorischer Insuffizienz (ARI) zum Einsatz. In Form der Heimbeatmung wird NIV bei CVI infolge neuromuskulärer und thorakorestriktiver Erkrankungen bereits bei geringgradiger CVI begonnen. Demgegenüber wird die Indikation zur NIV bei CVI infolge einer chronisch obstruktiven Lungenerkrankung (COPD), deren bronchopulmonale Pathophysiologie komplex ist, zurückhaltender gestellt. Neben der Zunahme der Lebenserwartung führt NIV bei CVI infolge neuromuskulärer und thorakorestriktiver Erkrankungen zur Verbesserung der Lebensqualität, körperlichen Ausdauer, maximalen Kraft der Atemmuskulatur, Schlafqualität und kognitiven Leistung. Für die CVI bei COPD wurde der günstige Therapieeffekt der NIV auf die Prognose bisher nicht eindeutig gezeigt.
Basierend auf der vorhandenen Evidenz ist der Einsatz von NIV vor allem zur Therapie der ARI bei der exazerbierten COPD, dem kardial bedingten Lungenödem und bei immunsupprimierten Patienten zu empfehlen. Demgegenüber kann für den hypoxämischen Typ der ARI keine Empfehlung zur breiten Anwendung der NIV ausgesprochen werden. Die Versagerquote der NIV ist insbesondere beim ARDS mit mehr als 50% hoch.
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Literatur
Clinical indications for noninvasive positive pressure ventilation in chronic respiratory failure due to restrictive lung disease, COPD, and nocturnal hypoventilation – a consensus conference report (1999). Chest 116:521–534
The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308
Antonelli M, Conti G, Bufi M et al () Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial. JAMA 283:235–241
Antonelli M, Conti G, Moro ML et al (2001) Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: a multi-center study. Intensive Care Med 27:1718–1728
Antonelli M, Conti G, Pelosi P et al (2002) New treatment of acute hypoxemic respiratory failure: noninvasive pressure support ventilation delivered by helmet – a pilot controlled trial. Crit Care Med 30:602–608
Auriant I, Jallot P, Hervé P et al (2001) Noninvasive ventilation reduces mortality in acute respiratory failure following lung resection. Am J Respir Crit Care Med 164:1231–1235
Azoulay E, Alberti C, Bornstain C et al (2001) Improved survival in cancer patients requiring mechanical ventilatory support: impact of noninvasive mechanical ventilatory support. Crit Care Med 29:519–525
Bott J, Baudouin SV, Moxham J (1991) Nasal intermittent positive pressure ventilation in the treatment of respiratory failure in obstructive sleep apnoea. Thorax 46:457–458
Brochard L, Mancebo J, Wysocki M et al (1995) Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 333:817–822
Budweiser S, Jorres RA, Riedl T et al (2007) Predictors of survival in COPD patients with chronic hypercapnic respiratory failure receiving noninvasive home ventilation. Chest 131:1650–1658
Carlucci A, Gregoretti C, Squadrone V, Navalesi P, Delmastro M, Nava S (2001) Preventive use of non-invasive mechanical ventilation to avoid post- Extubation respiratory failure: a randomised controlled study. Eur Respir J 18 (suppl 33):306
Confalonieri M, Potena A, Carbone G, Porta RD, Tolley EA, Meduri UG (1999) Acute respiratory failure in patients with severe community-acquired pneumonia. A prospective randomized evaluation of noninvasive ventilation. Am J Respir Crit Care Med 160:1585–1591
Conti G, Antonelli M, Navalesi P et al (2002) Noninvasive vs. conventional mechanical ventilation in patients with chronic obstructive pulmonary disease after failure of medical treatment in the ward: a randomized trial. Intensive Care Med 28:1701–1707
Craven DE, Duncan RA (2006) Preventing ventilator-associated pneumonia: tiptoeing through a minefield. Am J Respir Crit Care Med 173:1297–1298
Crieé CP, Laier-Groeneveld G (1995) Die Atempumpe. Thieme, Stuttgart
Cuomo A, Delmastro M, Ceriana P et al (2004) Noninvasive mechanical ventilation as a palliative treatment of acute respiratory failure in patients with end-stage solid cancer. Palliat Med 18:602–610
Domenighetti G, Gayer R, Gentilini R (2002) Noninvasive pressure support ventilation in non-COPD patients with acute cardiogenic pulmonary edema and severe community-acquired pneumonia: acute effects and outcome. Intensive Care Med 28:1226–1232
Drinker P, Shaw LA (1929) An apparatus for the prolonged administration of artificial respiration: I. A design for adults and children. J Clin Invest 7:229–247
Esteban A, Frutos-Vivar F, Ferguson ND et al (2004) Noninvasive positivepressure ventilation for respiratory failure after extubation. N Engl J Med 350:2452–2460
Fagon JY, Chastre J, Hance AJ, Montravers P, Novara A, Gibert C (1993) Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med 94:281–288
Ferrer M, Esquinas A, Leon M, Gonzalez G, Alarcon A, Torres A (2003) Noninvasive ventilation in severe hypoxemic respiratory failure: a randomized clinical trial. Am J Respir Crit Care Med 168:1438–1444
Ferrer M, Valencia M, Nicolas JM, Bernadich O, Badia JR, Torres A (2006) Early noninvasive ventilation averts extubation failure in patients at risk: a randomized trial. Am J Respir Crit Care Med 173:164–170
Hilbert G, Gruson D, Portel L, Gbikpi- Benissan G, Cardinaud JP (1998) Noninvasive pressure support ventilation in COPD patients with postextubation hypercapnic respiratory insufficiency. Eur Respir J 11:1349–1353
Hilbert G, Gruson D, Vargas F et al (2001) Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med 344:481–487
Hoffmann B, Jepsen M, Hachenberg T, Huth C, Welte T (2003) Cardiopulmonary effects of non-invasive positive pressure ventilation (NPPV) – a controlled, prospective study. Thorac Cardiovasc Surg 51:142–146
Keenan SP, Powers C, McCormack DG, Block G (2002) Noninvasive positivepressure ventilation for postextubation respiratory distress: a randomized controlled trial. JAMA 287:3238–3244
Kerby GR, Mayer LS, Pingleton SK (1987) Nocturnal positive pressure ventilation via nasal mask. Am Rev Respir Dis 135:738–740
Köhler D, Pfeifer M, Criée C (2006) Pathophysiologische Grundlagen der mechanischen Beatmung. Pneumologie 60:100–110
Köhler D, Schönhofer B (2006) Pneumologie und Beatmungsmedizin. Pneumologie 60:79
Köhnlein T, Criée CP, Köhler D, Welte T, Laier-Groeneveld G (2004) Multizentrische Studie: „Nicht-invasive Beatmung bei Patienten mit schwerer chronisch obstruktiver Bronchitis und Emphysem (COPD)“. Pneumologie 58:566–569
Kollef MH (2004) Prevention of hospital- associated pneumonia and ventilator- associated pneumonia. Crit Care Med 32:1396–1405
Kolodziej MA, Jensen L, Rowe B, Sin D (2007) Systematic review of noninvasive positive pressure ventilation in severe stable COPD. Eur Respir J 30:293–306
Kramer N, Meyer TJ, Meharg J, Cece RD, Hill NS (1995) Randomized, prospective trial of noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med 151:1799–1806
Kwok H, McCormack J, Cece R, Houtchens J, Hill NS (2003) Controlled trial of oronasal versus nasal mask ventilation in the treatment of acute respiratory failure. Crit Care Med 31:468–473
Lassen HCA (1953) A preliminary report on the 1952 epidemic of poliomyelitis in Copenhagen with special reference to the treatment of acute respiratory insufficiency. Lancet 1:37–40
Levy RD, Bradley TD, Newman SL, Macklem PT, Martin JG (1989) Negative pressure ventilation. Effects on ventilation during sleep in normal subjects. Chest 95:95–99
Lewarski JS, Gay PC (2007) Current issues in home mechanical ventilation. Chest 132:671–676
Lightowler JV, Wedzicha JA, Elliott MW, Ram FS (2003) Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. BMJ 326:185
Lloyd-Owen SJ, Donaldson GC, Ambrosino N et al (2005) Patterns of home mechanical ventilation use in Europe: results from the Eurovent survey. Eur Respir J 25:1025–1031
Martin TJ, Hovis JD, Costantino JP et al (2000) A randomized, prospective evaluation of noninvasive ventilation for acute respiratory failure. Am J Respir Crit Care Med 161:807–813
Masip J, Betbese AJ, Paez J et al (2000) Non-invasive pressure support ventilation versus conventional oxygen therapy in acute cardiogenic pulmonary oedema: a randomised trial. Lancet 356:2126–2132
Mokhlesi B, Tulaimat A (2007) Recent advances in obesity hypoventilation syndrome. Chest 132:1322–1336
Nava S, Carbone G, DiBattista N et al (2003) Noninvasive ventilation in cardiogenic pulmonary edema: a multicenter randomized trial. Am J Respir Crit Care Med 168:1432–1437
Nava S, Cuomo AM (2004) Acute respiratory failure in the cancer patient: the role of non-invasive mechanical ventilation. Crit Rev Oncol Hematol 51:91–103
Nava S, Evangelisti I, Rampulla C, Compagnoni ML, Fracchia C, Rubini F (1997) Human and financial costs of noninvasive mechanical ventilation in patients affected by COPD and acute respiratory failure. Chest 111:1631–1638
Nava S, Gregoretti C, Fanfulla F et al (2005) Noninvasive ventilation to prevent respiratory failure after extubation in high-risk patients. Crit Care Med 33:2465–2470
Nava S, Sturani C, Hartl S et al (2007) End-of-life decision-making in respiratory intermediate care units: a European survey. Eur Respir J 30:156–164
Plant PK, Owen JL, Elliott MW (2000) Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial. Lancet 355:1931–1935
Rusterholtz T, Kempf J, Berton C et al (1999) Noninvasive pressure support ventilation (NIPSV) with face mask in patients with acute cardiogenic pulmonary edema (ACPE). Intensive Care Med 25:21–28
Schönhofer B (2006) Nicht-invasive Beatmung. Uni-med, Bremen
Schönhofer B, Euteneuer S, Nava S, Suchi S, Köhler D (2002) Survival of mechanically ventilated patients admitted to a specialised weaning centre. Intensive Care Med 28:908–916
Schönhofer B, Köhler D (1994) Ventilatorische Insuffizienz und hyperkapnische Kompensation infolge chronisch belasteter „Atempumpe“. Dtsch Med Wochenschr 119:1209–1214
Schönhofer B, Köhler D (1997) Hyperkapnie. Intensivmed 34:501–512
Schönhofer B, Köhler D (1998) Therapeutische Strategien der ventilatorischen Insuffizienz bei amyotropher Lateralsklerose (ALS). Nervenarzt 69:312–319
Schönhofer B, Köhler D, Kutzer K (2006) Ethische Betrachtungen zur Beatmungsmedizin unter besonderer Berücksichtigung des Lebensendes. Pneumologie 60:408–416
Schönhofer B, Sortor-Leger S (2002) Equipment needs for noninvasive mechanical ventilation. Eur Respir J 20:1029–1036
Schönhofer B, Wagner TOF (2006) Ort der maschinellen Beatmung im Beatmungszentrum – Intensivstation, Intermediate care oder spezialisierte Normalstation. Pneumologie 60:376–382
Schönhofer B, Windisch W (2007) Die Atempumpe. In: Bein T, Pfeifer M (Hrsg) Intensivbuch Lunge. Med Wissenschaftliche Verlagsgesellschaft, S27–31
Schucher B, Magnussen H (2007) Beatmung bei chronisch ventilatorischer Insuffizienz. Pneumologie 61:644–652
Tobin MJ (2001) Advances in mechanical ventilation. N Engl J Med 344:1986–1996
Wijkstra PJ, Lacasse Y, Guyatt GH et al (2003) A meta-analysis of nocturnal noninvasive positive pressure ventilation in patients with stable COPD. Chest 124:337–343
Winck JC, Azevedo LF, Costa-Pereira A, Antonelli M, Wyatt JC (2006) Efficacy and safety of non-invasive ventilation in the treatment of acute cardiogenic pulmonary edema – a systematic review and meta-analysis. Crit Care 10:R69
Windisch W, Kostic S, Dreher M, Virchow JC Jr, Sorichter S (2005) Outcome of patients with stable COPD receiving controlled noninvasive positive pressure ventilation aimed at a maximal reduction of Pa(CO2). Chest 128:657–662
Wysocki M, Tric L, Wolff MA, Millet H, Herman B (1995) Noninvasive pressure support ventilation in patients with acute respiratory failure. A randomized comparison with conventional therapy. Chest 107:761–768
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Schönhofer, B. Nichtinvasive Beatmung – gestern, heute und morgen. Intensivmed 45, 182–193 (2008). https://doi.org/10.1007/s00390-008-0883-1
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DOI: https://doi.org/10.1007/s00390-008-0883-1