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Nichtinvasive Beatmung bei COPD

Non-invasive mechanical ventilation in COPD

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Zusammenfassung

Die nichtinvasive Beatmung ist die Methode der Wahl beim akuten respiratorischen Versagen von Patienten mit chronisch-obstruktiver Lungenkrankheit (COPD). Die Beachtung der Kontraindikationen und Abbruchkriterien stellt sicher, dass eine notwendige Intubation nicht verzögert wird. Als primäres Interface wird üblicherweise eine Nasen-Mund-Maske gewählt. Eine vorsichtige Sedierung kann bei manchen Patienten erforderlich sein. Bei schwer entwöhnbaren Patienten mit COPD kann die nichtinvasive Beatmung unter bestimmten Voraussetzungen eine Extubation ermöglichen. Unabhängig davon benötigen Patienten mit COPD nach einer primär erfolgreichen Extubation oft eine präventive nichtinvasive Nachbeatmung, um eine Reintubation zu vermeiden. Eine nächtliche nichtinvasive Heimbeatmung ist für manche chronisch hyperkapnische Patienten eine Option. Sie sollte in einem Behandlungszentrum eingeleitet und kontrolliert werden.

Abstract

Non-invasive mechanical ventilation is the preferred method for the treatment of acute respiratory failure in patients with chronic obstructive pulmonary disease (COPD). Primary contraindications and stopping criteria must be regarded to avoid delaying endotracheal intubation. The primary interface is usually a nasal–oral mask. Cautious sedation can facilitate non-invasive ventilation in some patients. Under certain circumstances non-invasive ventilation may enable successful extubation in COPD patients with prolonged weaning. COPD patients can also benefit from preventive non-invasive ventilation in order to avoid re-intubation after a planned extubation. Domiciliary nocturnal non-invasive ventilation is an option for some patients with COPD in chronic hypercapnic respiratory failure. This treatment should be established in a specialised unit.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Vortragshonorare von Hein-Löwenstein, Orion Pharma, Draeger.

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  1. I. Interne Lungenabteilung mit Intensivstation, Otto-Wagner-Spital, Sanatoriumstr. 2, 1140, Wien, Österreich

    G.-C. Funk

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Funk, GC. Nichtinvasive Beatmung bei COPD. Med Klin Intensivmed Notfmed 107, 185–191 (2012). https://doi.org/10.1007/s00063-011-0067-9

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