Intensivmedizin und Notfallmedizin

, Volume 45, Issue 4, pp 182–193 | Cite as

Nichtinvasive Beatmung – gestern, heute und morgen

ÜBERSICHT
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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.

Schlüsselwörter

Nichtinvasive Beatmung akute respiratorische Insuffizienz chronisch ventilatorische Insuffizienz 

Noninvasive mechanical ventilation – yesterday, today and tomorrow

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.

Key words

noninvasive mechanical ventilation acute respiratory failure chronic ventilatory insufficiency 

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Copyright information

© Steinkopff-Verlag 2008

Authors and Affiliations

  1. 1.Abteilung für Pneumologie und Internistische IntensivmedizinKrankenhaus Oststadt-Heidehaus, Klinikum Region HannoverHannover

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