Der Pneumologe

, 5:150 | Cite as

Weaning vom Respirator beginnt mit der Intubation

Aktuelle Konzepte der Beatmungsentwöhnung
Leitthema

Zusammenfassung

Mit zunehmender Technisierung und Invasivität der Intensivmedizin, aber auch steigender Komorbidität und höherem Alter der Patienten wächst die Anzahl der Patienten, die nur schwierig vom Respirator entwöhnbar sind bzw. eine Langzeitbeatmung (LZB) benötigen. Die Erschöpfung der Atmungsmuskulatur ist die wesentliche Ursache für die erfolglose Entwöhnung vom Respirator (Weaning). In spezialisierten Entwöhnungseinheiten gelingt die Respiratorentwöhnung mithilfe einer therapeutischen Gesamtstrategie relativ häufig. Es ist wichtig, bereits zum Zeitpunkt der Intubation und in der frühen Beatmungsphase wichtige Prinzipien der Respiratorentwöhnung zu beachten, um spätere Komplikationen und eine LZB möglichst zu verhindern. Schließlich bleiben Weaning in der Terminalphase und Sterben am Respirator eine große Herausforderung für alle Beteiligten.

Schlüsselwörter

Schwierige Entwöhnung vom Respirator Langzeitbeatmung Atmungsmuskulatur Entwöhnungseinheit Lebensende 

Weaning from a respirator begins with intubation

Current concepts of ventilation weaning

Abstract

The prevalence of difficult weaning or prolonged mechanical ventilation is increasing due to a growing number of multi-morbid, elderly and pulmonary-deficient patients being mechanically ventilated. Respiratory failure is frequently caused by overloaded respiratory muscles and/or reduced capacity of the respiratory muscles. In specialized facilities, complex weaning strategies are often successful. These strategies must be considered as soon as possible in order to avoid late complications and prolonged mechanical ventilation. Terminal weaning and end-of-life issues continue to pose a challenge to everyone involved.

Keywords

Difficult weaning Prolonged mechanical ventilation Respiratory muscles Weaning unit End of life 

Literatur

  1. 1.
    Cox CE, Carson SS, Holmes GM et al. (2004) Increase in tracheostomy for prolonged mechanical ventilation in North Carolina, 1993–2002. Crit Care Med 32: 2219–2226PubMedGoogle Scholar
  2. 2.
    Boles JM, Bion J, Connors A et al. (2007) Weaning from mechanical ventilation. Eur Respir J 29: 1033–1056PubMedGoogle Scholar
  3. 3.
    Esteban A, Alia I, Ibanez J et al. (1994) Modes of mechanical ventilation and weaning. A national survey of Spanish hospitals. The Spanish Lung Failure Collaborative Group. Chest 106: 1188–1193PubMedGoogle Scholar
  4. 4.
    Kollef MH, Shapiro SD, Silver P et al. (1997) A randomized, controlled trial of protocol-directed versus physician-directed weaning from mechanical ventilation. Crit Care Med 25: 567–574PubMedGoogle Scholar
  5. 5.
    Ely EW, Baker AM, Dunagan DP et al. (1996) Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 335: 1864–1869PubMedGoogle Scholar
  6. 6.
    Gillespie DJ, Marsh HM, Divertie MB et al. (1986) Clinical outcome of respiratory failure in patients requiring prolonged (greater than 24 hours) mechanical ventilation. Chest 90: 364–369PubMedGoogle Scholar
  7. 7.
    MacIntyre NR, Cook DJ, Ely EW Jr et al. (2001) Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest 120: 375S–395SPubMedGoogle Scholar
  8. 8.
    Seneff MG, Zimmerman JE, Knaus WA et al. (1996) Predicting the duration of mechanical ventilation. The importance of disease and patient characteristics. Chest 110: 469–479PubMedGoogle Scholar
  9. 9.
    Epstein SK, Vuong V (1999) Lack of influence of gender on outcomes of mechanically ventilated medical ICU patients. Chest 116: 732–739PubMedGoogle Scholar
  10. 10.
    Esteban A, Frutos F, Tobin MJ et al. (1995) A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group. N Engl J Med 332: 345–350PubMedGoogle Scholar
  11. 11.
    Brochard L, Rauss A, Benito S et al. (1994) Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med 150: 896–903PubMedGoogle Scholar
  12. 12.
    MacIntyre NR (2005) Respiratory mechanics in the patient who is weaning from the ventilator. Respir Care 50: 275–286; discussion 284–286PubMedGoogle Scholar
  13. 13.
    Schönhofer B, Euteneuer S, Nava S et al. (2002) Survival of mechanically ventilated patients admitted to a specialised weaning centre. Intensive Care Med 28: 908–916PubMedGoogle Scholar
  14. 14.
    Jubran A, Tobin MJ (1997) Passive mechanics of lung and chest wall in patients who failed or succeeded in trials of weaning. Am J Respir Crit Care Med 155: 916–921PubMedGoogle Scholar
  15. 15.
    Vassilakopoulos T, Zakynthinos S, Roussos C (1996) Respiratory muscles and weaning failure. Eur Respir J 9: 2383–2400PubMedGoogle Scholar
  16. 16.
    Crieé CP, Laier-Groeneveld G (1995) Die Atempumpe. Thieme, StuttgartGoogle Scholar
  17. 17.
    Tobin MJ (2001) Advances in mechanical ventilation. N Engl J Med 344: 1986–1996PubMedGoogle Scholar
  18. 18.
    Laghi F, Tobin MJ (2003) Disorders of the respiratory muscles. Am J Respir Crit Care Med 168: 10–48PubMedGoogle Scholar
  19. 19.
    Yang KL, Tobin MJ (1991) A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med 324: 1445–1450PubMedGoogle Scholar
  20. 20.
    Schönhofer B, Köhler D (1994) Ventilatorische Insuffizienz und hyperkapnische Kompensation infolge chronisch belasteter „Atempumpe“. Dtsch Med Wochenschr 119: 1209–1214PubMedGoogle Scholar
  21. 21.
    Schönhofer B, Windisch W (2007) Die Atempumpe. In: Bein T, Pfeifer M (Hrsg) Intensivbuch Lunge. Med Wissenschaftliche Verlagsgesellschaft, Berlin, S 27–31Google Scholar
  22. 22.
    Schönhofer B, Böhrer H, Köhler D (1998) Blood transfusion facilitating difficult weaning from the ventilator. Anaesthesia 53: 181–184PubMedGoogle Scholar
  23. 23.
    Kress JP, Pohlman AS, Alverdy J et al. (1999) The impact of morbid obesity on oxygen cost of breathing (VO(2RESP)) at rest. Am J Respir Crit Care Med 160: 883–886PubMedGoogle Scholar
  24. 24.
    Barchfeld T, Schönhofer B, Wenzel M et al. (1997) Work of breathing in differentiation of various forms of sleep-related breathing disorders. Pneumologie 51: 931–935PubMedGoogle Scholar
  25. 25.
    Garnacho-Montero J, Amaya-Villar R, Garcia-Garmendia JL et al. (2005) Effect of critical illness polyneuropathy on the withdrawal from mechanical ventilation and the length of stay in septic patients. Crit Care Med 33: 349–354PubMedGoogle Scholar
  26. 26.
    De Jonghe B, Sharshar T, Lefaucheur JP et al. (2002) Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA 288: 2859–2867Google Scholar
  27. 27.
    Kang SW, Bach JR (2000) Maximum insufflation capacity: vital capacity and cough flows in neuromuscular disease. Am J Phys Med Rehabil 79: 222–227PubMedGoogle Scholar
  28. 28.
    Girou E (2000) Controlling nosocomial infection: everyone is concerned. Arch Dermatol 136: 785–786PubMedGoogle Scholar
  29. 29.
    Girou E, Schortgen F, Delclaux C et al. (2000) Association of noninvasive ventilation with nosocomial infections and survival in critically ill patients. JAMA 284: 2361–2367PubMedGoogle Scholar
  30. 30.
    Fagon JY, Chastre J, Hance AJ et al. (1993) Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med 94: 281–288PubMedGoogle Scholar
  31. 31.
    Schönhofer B, Barchfeld T, Haidl P et al. (1999) Scintigraphy for evaluating early aspiration after oral feeding in patients receiving prolonged ventilation via tracheostomy. Intensive Care Med 25: 311–314PubMedGoogle Scholar
  32. 32.
    Scheinhorn DJ, Chao DC, Stearn-Hassenpflug M et al. (2003) Ventilator-dependent survivors of catastrophic illnesses: a multicenter outcomes study. Am J Respir Crit Care Med 167: A458Google Scholar
  33. 33.
    Srivastava S, Chatila W, Amoateng-Adjepong Y et al. (1999) Myocardial ischemia and weaning failure in patients with coronary artery disease: an update. Crit Care Med 27: 2109–2112PubMedGoogle Scholar
  34. 34.
    Lemaire F, Teboul JL, Cinotti L et al. (1988) Acute left ventricular dysfunction during unsuccessful weaning from mechanical ventilation. Anesthesiology 69: 171–179PubMedGoogle Scholar
  35. 35.
    Roussos C, Macklem P (1982) Medical progress: the respiratory muscles. N Engl J Med 307: 786–797PubMedGoogle Scholar
  36. 36.
    Ambrosino N, Clini E (2004) Long-term mechanical ventilation and nutrition. Respir Med 98: 413–420PubMedGoogle Scholar
  37. 37.
    Modawal A, Candadai NP, Mandell KM et al. (2002) Weaning success among ventilator-dependent patients in a rehabilitation facility. Arch Phys Med Rehabil 83: 154–157PubMedGoogle Scholar
  38. 38.
    Celli BR, Cote CG, Marin JM et al. (2004) The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med 350: 1005–1012PubMedGoogle Scholar
  39. 39.
    Ely EW, Shintani A, Truman B et al. (2004) Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 291: 1753–1762PubMedGoogle Scholar
  40. 40.
    Hendra KP, Bonis PA, Joyce-Brady M (2003) Development and prospective validation of a model for predicting weaning in chronic ventilator dependent patients. BMC Pulm Med 3: 3PubMedGoogle Scholar
  41. 41.
    Parthasarathy S, Tobin MJ (2004) Sleep in the intensive care unit. Intensive Care Med 30: 197–206PubMedGoogle Scholar
  42. 42.
    Kollef MH, Levy NT, Ahrens TS et al. (1998) The use of continuous i.v. sedation is associated with prolongation of mechanical ventilation. Chest 114: 541–548PubMedGoogle Scholar
  43. 43.
    Cohen IL, Booth FV (1994) Cost containment and mechanical ventilation in the United States. New Horiz 2: 283–290PubMedGoogle Scholar
  44. 44.
    Pilcher DV, Bailey MJ, Treacher DF et al. (2005) Outcomes, cost and long term survival of patients referred to a regional weaning centre. Thorax 60: 187–192PubMedGoogle Scholar
  45. 45.
    Schönhofer B, Haidl P, Kemper P et al. (1999) Entwöhnung vom Respirator („Weaning“) bei Langzeitbeatmung. Dtsch Med Wochenschr 124: 1022–1028PubMedGoogle Scholar
  46. 46.
    Scheinhorn DJ, Artinian BM, Catlin JL (1994) Weaning from prolonged mechanical ventilation. The experience at a regional weaning center. Chest 105: 534–539PubMedGoogle Scholar
  47. 47.
    Schönhofer B (1999) Respiratory high-dependency units in Germany. Monaldi Arch Chest Dis 54: 448–451PubMedGoogle Scholar
  48. 48.
    Becker HF, Schönhofer B, Vogelmeier C (2006) Intermediate care und nicht-invasive Beatmung. Med Klin 101: 334–339Google Scholar
  49. 49.
    Schönhofer B, Berndt C, Achtzehn U et al. (2008) Entwöhnung von der Beatmungstherapie – eine Erhebung zur Situation pneumologischer Weaningzentren in Deutschland. Dtsch Med Wochenschr 133: 700–704PubMedGoogle Scholar
  50. 50.
    Epstein SK (2002) Decision to extubate. Intensive Care Med 28: 535–546PubMedGoogle Scholar
  51. 51.
    Epstein SK, Nevins ML, Chung J (2000) Effect of unplanned extubation on outcome of mechanical ventilation. Am J Respir Crit Care Med 161: 1912–1916PubMedGoogle Scholar
  52. 52.
    Khamiees M, Raju P, DeGirolamo A et al. (2001) Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial. Chest 120: 1262–1270PubMedGoogle Scholar
  53. 53.
    Schönhofer B (2000) Predictors of weanability. Monaldi Arch Chest Dis 55: 339–344PubMedGoogle Scholar
  54. 54.
    Knaus W, Draper E, Wagner D et al. (1985) APACHE II: a severity of disease classification system. Crit Care Med 13: 818–829PubMedGoogle Scholar
  55. 55.
    Schönhofer B, Lefering R, Suchi S et al. (2002) Umfrage zur Einschätzung von Score-Systemen durch Intensivmediziner. Intensivmed 39: 240–245Google Scholar
  56. 56.
    Schönhofer B, Guo JJ, Suchi S et al. (2004) The use of APACHE II prognostic system in difficult-to-wean patients after long-term mechanical ventilation. Eur J Anaesthesiol 21: 558–565PubMedGoogle Scholar
  57. 57.
    Farias JA, Retta A, Alia I et al. (2001) A comparison of two methods to perform a breathing trial before extubation in pediatric intensive care patients. Intensive Care Med 27: 1649–1654PubMedGoogle Scholar
  58. 58.
    Esteban A, Alia I, Tobin MJ et al. (1999) Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation. Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med 159: 512–518PubMedGoogle Scholar
  59. 59.
    McLean SE, Jensen LA, Schroeder DG et al. (2006) Improving adherence to a mechanical ventilation weaning protocol for critically ill adults: outcomes after an implementation program. Am J Crit Care 15: 299–309PubMedGoogle Scholar
  60. 60.
    Kress JP, Pohlman AS, O’Connor MF et al. (2000) Daily interruption of sedative infusion in critically ill patients undergoing mechanical ventilation. N Engl J Med 342: 1471–1477PubMedGoogle Scholar
  61. 61.
    Krishnan JA, Moore D, Robeson C et al. (2004) A prospective, controlled trial of a protocol-based strategy to discontinue mechanical ventilation. Am J Respir Crit Care Med 169: 673–678PubMedGoogle Scholar
  62. 62.
    Milic-Emili J (1986) Is weaning an art or a science? Am Rev Respir Dis 134: 1107–1108PubMedGoogle Scholar
  63. 63.
    Esteban A, Anzueto A, Alia I et al. (2000) How is mechanical ventilation employed in the intensive care unit? An international utilization review. Am J Respir Crit Care Med 161: 1450–1458PubMedGoogle Scholar
  64. 64.
    Schild K, Neusch C, Schönhofer B (2008) Ventilator induzierter Zwerchfellschaden. Pneumologie 62: 33–39PubMedGoogle Scholar
  65. 65.
    Lellouche F, Mancebo J, Jolliet P et al. (2006) A multicenter randomized trial of computer-driven protocolized weaning from mechanical ventilation. Am J Respir Crit Care Med 174: 894–900PubMedGoogle Scholar
  66. 66.
    Schönhofer B, Mang H, Haidl P et al. (1996) Controlled mechanical ventilation in conscious patients – a concept for patients difficult to wean. Appl Cardiopulm Pathophysiol 6: 201–215Google Scholar
  67. 67.
    Flick GR, Bellamy PE, Simmons DH (1989) Diaphragmatic contraction during assisted mechanical ventilation. Chest 96: 130–135PubMedGoogle Scholar
  68. 68.
    Imsand C, Feihl F, Perret C et al. (1994) Regulation of inspiratory neuromuscular output during synchronized intermittent mechanical ventilation. Anesthesiology 80: 13–22PubMedGoogle Scholar
  69. 69.
    Marini JJ, Capps JS, Culver BH (1985) The inspiratory work of breathing during assisted mechanical ventilation. Chest 87: 612–618PubMedGoogle Scholar
  70. 70.
    Marini JJ, Smith TC, Lamb VJ (1988) External work output and force generation during synchronized intermittent mechanical ventilation. Effect of machine assistance on breathing effort. Am Rev Respir Dis 138: 1169–1179PubMedGoogle Scholar
  71. 71.
    Gibney RT, Wilson RS, Pontoppidan H (1982) Comparison of work of breathing on high gas flow and demand valve continuous positive airway pressure systems. Chest 82: 692–695PubMedGoogle Scholar
  72. 72.
    Sassoon CS, Caiozzo VJ, Manka A et al. (2002) Altered diaphragm contractile properties with controlled mechanical ventilation. J Appl Physiol 92: 2585–2595PubMedGoogle Scholar
  73. 73.
    Vassilakopoulos T, Petrof BJ (2004) Ventilator-induced diaphragmatic dysfunction. Am J Respir Crit Care Med 169: 336–341PubMedGoogle Scholar
  74. 74.
    Nathens AB, Neff MJ, Jurkovich GJ et al. (2002) Randomized, prospective trial of antioxidant supplementation in critically ill surgical patients. Ann Surg 236: 814–822PubMedGoogle Scholar
  75. 75.
    Shapiro M, Wilson RK, Casar G et al. (1986) Work of breathing through different sized endotracheal tubes. Crit Care Med 14: 1028–1031PubMedGoogle Scholar
  76. 76.
    Boque MC, Gualis B, Sandiumenge A et al. (2004) Endotracheal tube intraluminal diameter narrowing after mechanical ventilation: use of acoustic reflectometry. Intensive Care Med 30: 2204–2209PubMedGoogle Scholar
  77. 77.
    Maeda Y, Fujino Y, Uchiyama A et al. (2003) Does the tube-compensation function of two modern mechanical ventilators provide effective work of breathing relief? Crit Care 7: R92–R97PubMedGoogle Scholar
  78. 78.
    Epstein SK (2005) Anatomy and physiology of tracheostomy. Respir Care 50: 476–482PubMedGoogle Scholar
  79. 79.
    Dulguerov P, Gysin C, Perneger TV et al. (1999) Percutaneous or surgical tracheostomy: a meta-analysis. Crit Care Med 27: 1617–1625PubMedGoogle Scholar
  80. 80.
    Rumbak MJ, Newton M, Truncale T et al. (2004) A prospective, randomized study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Crit Care Med 32: 1689–1694PubMedGoogle Scholar
  81. 81.
    Antonelli M, Michetti V, Di Palma A et al. (2005) Percutaneous translaryngeal versus surgical tracheostomy: a randomized trial with 1-yr double-blind follow-up. Crit Care Med 33: 1015–1020PubMedGoogle Scholar
  82. 82.
    Rosenblüh J, Schönhofer B, Kemper P et al. (1994) Bedeutung von Platzhaltern tracheotomierter Patienten während der Entwöhnungsphase nach Langzeitbeatmung. Med Klin 89: S61–S63Google Scholar
  83. 83.
    Ceriana P, Carlucci A, Navalesi P et al. (2003) Weaning from tracheotomy in long-term mechanically ventilated patients: feasibility of a decisional flowchart and clinical outcome. Intensive Care Med 29: 845–848PubMedGoogle Scholar
  84. 84.
    Nava S, Ambrosino N, Clini E et al. (1998) Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease. A randomized, controlled trial. Ann Intern Med 128: 721–728PubMedGoogle Scholar
  85. 85.
    Ferrer M, Esquinas A, Arancibia F et al. (2003) Noninvasive ventilation during persistent weaning failure: a randomized controlled trial. Am J Respir Crit Care Med 168: 70–76PubMedGoogle Scholar
  86. 86.
    Epstein SK, Ciubotaru RL (1998) Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation. Am J Respir Crit Care Med 158: 489–493PubMedGoogle Scholar
  87. 87.
    Carlucci A, Gregoretti C, Squadrone V et al. (2001) Preventive use of non-invasive mechanical ventilation to avoid post-extubation respiratory failure: a randomised controlled study. Eur Respir J (Suppl 33) 18: 306Google Scholar
  88. 88.
    Hilbert G, Gruson D, Portel L et al. (1998) Noninvasive pressure support ventilation in COPD patients with postextubation hypercapnic respiratory insufficiency. Eur Respir J 11: 1349–1353PubMedGoogle Scholar
  89. 89.
    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: 2465–2470PubMedGoogle Scholar
  90. 90.
    Ferrer M, Valencia M, Nicolas JM et al. (2006) Early noninvasive ventilation averts extubation failure in patients at risk: a randomized trial. Am J Respir Crit Care Med 173: 164–170PubMedGoogle Scholar
  91. 91.
    Keenan SP, Powers C, McCormack DG et al. (2002) Noninvasive positive-pressure ventilation for postextubation respiratory distress: a randomized controlled trial. JAMA 287: 3238–3244PubMedGoogle Scholar
  92. 92.
    Esteban A, Frutos-Vivar F, Ferguson ND et al. (2004) Noninvasive positive-pressure ventilation for respiratory failure after extubation. N Engl J Med 350: 2452–2460PubMedGoogle Scholar
  93. 93.
    Schönhofer B, Harms W, Lefering R et al. (2008) Stellenwert des TISS-28 Scores in der schwierigen Entwöhnung vom Respirator. Med Klinik (im Druck)Google Scholar
  94. 94.
    Schönhofer B, Wenzel M, Geibel M et al. (1998) Blood transfusion and lung function in chronically anemic patients with severe chronic obstructive pulmonary disease. Crit Care Med 26: 1824–1828PubMedGoogle Scholar
  95. 95.
    Schönhofer B, Geibel M, Stickeler P et al. (1997) Endoscopic placement of a tracheal oxygen catheter: a new technique. Intensive Care Med 23: 445–449PubMedGoogle Scholar
  96. 96.
    Schönhofer B, Köhler D (1998) Stellenwert von oral appliziertem retardiertem Morphin zur Therapie des schwergradigen Lungenemphysems vom Pink-Puffer-Typ. Dtsch Med Wochenschr 123: 1433–1438PubMedGoogle Scholar
  97. 97.
    Kreymann KG, Heer G de, Felbinger T et al. (2007) Ernährungskonzepte bei Intensivpatienten. Pneumologie 61: 574–580PubMedGoogle Scholar
  98. 98.
    Bassili HR, Deitel M (1991) Nutritional support in long term intensive care with special reference to ventilator patients: a review. Can Anaesth Soc 28: 17–21Google Scholar
  99. 99.
    Barr J, Hecht M, Flavin kE et al. (2004) Outcomes in critically Ill patients before and after the implementation of an evidence-based nutritional management protocol. Chest 125: 1446–1457PubMedGoogle Scholar
  100. 100.
    Artinian V, Krayem H, DiGiovine B (2006) Effects of early enteral feeding on the outcome of critically ill mechanically ventilated medical patients. Chest 129: 960–967PubMedGoogle Scholar
  101. 101.
    Bolton CF, Breuer AC (1999) Critical illness polyneuropathy. Muscle Nerve 22: 419–424PubMedGoogle Scholar
  102. 102.
    Burdet L, Muralt B de, Schutz Y et al. (1997) Administration of growth hormone to underweight patients with chronic obstructive pulmonary disease. A prospective randomized controlled study. Am J Respir Crit Care Med 156: 1800–1806PubMedGoogle Scholar
  103. 103.
    Ferreira I, Verreschi I, Nery L et al. (1998) The influence of 6 months of oral anabolic steroids on body mass and respiratory muscles in undernourished COPD patients. Chest 114: 19–28PubMedGoogle Scholar
  104. 104.
    Schols AMW, Soeters PB, Mostert R et al. (1995) Physiologic effects of nutritional support and anabolic steroids in patients with chronic obstructive pulmonary disease. A placebo-controlled randomized trial. Am J Respir Crit Care Med 152: 1268–1274PubMedGoogle Scholar
  105. 105.
    Granberg Axell AI, Malmros CW, Bergbom IL et al. (2002) Intensive care unit syndrome/delirium is associated with anemia, drug therapy and duration of ventilation treatment. Acta Anaesthesiol Scand 46: 726–731Google Scholar
  106. 106.
    Burns AM, Shelly MP, Park GR (1992) The use of sedative agents in critically ill patients. Drugs 43: 507–515PubMedGoogle Scholar
  107. 107.
    Shelly MP (1999) Sedation, where are we now? Intensive Care Med 25: 137–139PubMedGoogle Scholar
  108. 108.
    Ramsay MA, Savege TM, Simpson BR et al. (1974) Controlled sedation with alphaxalone-alphadolone. Br Med J 2: 656–659PubMedCrossRefGoogle Scholar
  109. 109.
    Ely EW, Inouye SK, Bernard GR et al. (2001) Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 286: 2703–2710PubMedGoogle Scholar
  110. 110.
    Siobal MS, Kallet RH, Kivett VA et al. (2006) Use of dexmedetomidine to facilitate extubation in surgical intensive-care-unit patients who failed previous weaning attempts following prolonged mechanical ventilation: a pilot study. Respir Care 51: 492–496PubMedGoogle Scholar
  111. 111.
    Martin UJ, Hincapie L, Nimchuk M et al. (2005) Impact of whole-body rehabilitation in patients receiving chronic mechanical ventilation. Crit Care Med 33: 2259–2265PubMedGoogle Scholar
  112. 112.
    Bach JR (1994) Update and perspective on noninvasive respiratory muscle aids. Part 2: Expiratory aids. Chest 105: 1538–1544PubMedGoogle Scholar
  113. 113.
    Chatwin M, Ross E, Hart N et al. (2003) Cough augmentation with mechanical insufflation/exsufflation in patients with neuromuscular weakness. Eur Respir J 21: 502–508PubMedGoogle Scholar
  114. 114.
    Gosselink R, Bott J, Connor M et al. (2008) Physiotherapy for adult patients with crirical care. Intensive Care Med (in press)Google Scholar
  115. 115.
    Karg O, Bonnet R, Magnussen H et al. (2004) Respiratory Therapist – Atmungstherapeut – Einführung eines neuen Berufsbildes. Pneumologie 58: 854–857PubMedGoogle Scholar
  116. 116.
    Chatila W, Kreimer DT, Criner GJ (2001) Quality of life in survivors of prolonged mechanical ventilatory support. Crit Care Med 29: 737–742PubMedGoogle Scholar
  117. 117.
    Hopkins RO, Weaver LK, Collingridge D et al. (2005) Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome. Am J Respir Crit Care Med 171: 340–347PubMedGoogle Scholar
  118. 118.
    Euteneuer S, Windisch W, Suchi S et al. (2006) Health-related quality of life in patients with chronic respiratory failure after long-term mechanical ventilation. Respir Med 100: 477–486PubMedGoogle Scholar
  119. 119.
    Hurel D, Loirat P, Saulnier F et al. (1997) Quality of life 6 months after intensive care: results of a prospective multicenter study using a generic health status scale and a satisfaction scale. Intensive Care Med 23: 331–337PubMedGoogle Scholar
  120. 120.
    Granja C, Lopes A, Moreira S et al. (2005) Patients‘ recollections of experiences in the intensive care unit may affect their quality of life. Crit Care 9: R96–R109PubMedGoogle Scholar
  121. 121.
    Hopkins RO, Gale SD, Weaver LK (2006) Brain atrophy and cognitive impairment in survivors of acute respiratory distress syndrome. Brain Inj 20: 263–271PubMedGoogle Scholar
  122. 122.
    Schönhofer B, Köhler D, Kutzer K (2006) Ethische Betrachtungen zur Beatmungsmedizin unter besonderer Berücksichtigung des Lebensendes. Pneumologie 60: 408–416PubMedGoogle Scholar
  123. 123.
    Ferrand E, Lemaire F, Regnier B et al. (2003) Discrepancies between perceptions by physicians and nursing staff of intensive care unit end-of-life decisions. Am J Respir Crit Care Med 167: 1310–1315PubMedGoogle Scholar
  124. 124.
    Thomas EJ, Sexton JB, Helmreich RL (2003) Discrepant attitudes about teamwork among critical care nurses and physicians. Crit Care Med 31: 956–959PubMedGoogle Scholar
  125. 125.
    Lo B, Ruston D, Kates LW et al. (2002) Discussing religious and spiritual issues at the end of life: a practical guide for physicians. JAMA 287: 749–754PubMedGoogle Scholar
  126. 126.
    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: 602–610PubMedGoogle Scholar
  127. 127.
    Nava S, Cuomo AM (2004) Acute respiratory failure in the cancer patient: the role of non-invasive mechanical ventilation. Crit Rev Oncol Hematol 51: 91–103PubMedGoogle Scholar
  128. 128.
    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: 156–164PubMedGoogle Scholar
  129. 129.
    Gianakos D (1995) Terminal weaning. Chest 108: 1405–1406PubMedGoogle Scholar
  130. 130.
    Nava S, Rubini F, Zanotti E et al. (1994) Survival and prediction of successful ventilator weaning in COPD patients requiring mechanical ventilation for more than 21 days. Eur Respir J 7: 1645–1652PubMedGoogle Scholar
  131. 131.
    Gracey DR, Naessens JM, Viggiano RW et al. (1995) Outcome of patients cared for in a ventilator-dependent unit in a general hospital. Chest 107: 494–499PubMedGoogle Scholar
  132. 132.
    Bagley PH, Cooney E (1997) A community-based regional ventilator weaning unit: development and outcomes. Chest 111: 1024–1029PubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

  1. 1.Abteilung für Pneumologie und internistische IntensivmedizinKlinikum Region Hannover GmbH, Krankenhaus Oststadt – HeidehausHannoverDeutschland

Personalised recommendations