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Intensivmedizin und Notfallmedizin

, Volume 48, Issue 4, pp 281–289 | Cite as

Differenzialdiagnose und Management von Weaningproblemen

  • G.-C. Funk
Leitthema
  • 377 Downloads

Zusammenfassung

Bei einem von sechs beatmeten Patienten verläuft die Entwöhnung vom Respirator (Weaning) prolongiert, was mit einer deutlich erhöhten Morbidität und Mortalität einhergeht. Bereits nach dem ersten gescheiterten Spontanatemversuch sollte nach dem oder den die Entwöhnung verhindernden Organsystem(en) gefahndet werden. Die konkrete Ursache von schwierigem Weaning kann am besten am Höhepunkt eines gescheiterten Spontanatemversuchs anhand der klinischen Untersuchung, der arteriellen und venösen Blutgase, der Echokardiographie und anderer Hilfsmittel festgestellt werden. Pathologische Atemmechanik, schwache bzw. überlastete Atemmuskulatur, Herzinsuffizienz und Myokardischämie sowie psychische Probleme können an bestimmten Befundkonstellationen erkannt werden. Reduktion der Atemarbeit, Training der Atemmuskulatur und Senkung von Vor- und Nachlast sind die entscheidenden Schritte zur Überwindung einer respiratorisch bzw. kardial limitierten Entwöhnbarkeit. Erfolgreiche Strategien zur Vermeidung von Weaningproblemen sind der sparsame Umgang mit Sedierung, der frühe Beginn mit einer strukturierten Entwöhnung sowie die frühe Rehabilitation schwacher Patienten.

Schlüsselwörter

Entwöhnung Beatmung Tracheotomie Intensivstation 

Diagnosis and management of difficult weaning from mechanical ventilation

Abstract

Of 6 ventilated ICU patients, 1 patient will experience prolonged weaning from mechanical ventilation. This is associated with a substantially increased morbidity and mortality. After one unsuccessful spontaneous breathing trial, the organ system preventing successful weaning should be identified. The mechanisms limiting weaning should be assessed toward the end of a failing spontaneous breathing trial using physical examination, arterial and venous blood gases, echocardiography, and other tools. Disturbed mechanics of the respiratory system, weakness of the ventilatory muscles, and weaning-induced cardiac dysfunction including myocardial ischemia are common causes of difficult or prolonged weaning. The respective therapeutic strategies are reduction of the work of breathing, ventilatory muscle training, and reducing cardiac preload as well as afterload. Weaning problems are preventable by a structured weaning strategy, including early spontaneous awakening and breathing trials as well as early rehabilitation of patients with ICU-acquired weakness.

Keywords

Ventilator weaning Ventilation, mechanical Tracheotomy Intensive care units 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Intensivstation, Erste Interne LungenabteilungOtto-Wagner-SpitalWienÖsterreich

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