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Beatmung eines ungeschützten Atemwegs

Evaluation eines neuen spitzenfluss- und druckbegrenzenden Beatmungsbeutels

Ventilation of an unprotected airway

Evaluation of a new peak-inspiratory-flow and airway-pressure-limiting bag-valve-mask

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Zusammenfassung

Hintergrund

Beim ungeschützten Luftweg werden aktuell nach 30 Thoraxkompressionen 2 Beatmungen mit einer Inspirationszeit von 1 s empfohlen; damit benötigt die Ventilation ca. 15% statt bisher ca. 40% der Reanimationszeit.

Methoden

Im Simulationsmodell wurde untersucht, wie sich eine von 2 auf 1 s reduzierte Beatmungszeit durch einen neuartigen spitzenfluss- und druckbegrenzenden Beatmungsbeutel (Smart-Bag®) bei kontinuierlich abfallendem unteren Ösophagussphinkterdruck (UÖSD) auf Atemmechanik und Magenbeatmung auswirkt.

Ergebnisse

Eine Verkürzung der Inspirationszeit von 2 auf 1 s führte zu niedrigeren Atemwegspitzendrücken bei einem UÖSD von 0,49 kPa (5 cmH2O), 0,98 kPa (10 cmH2O) sowie 1,47 kPa (15 cmH2O) und bei 1,96 kPa (20 cmH2O) zu höheren Atemwegsspitzendrücken. Die Lungentidalvolumina waren bei 1 s gegenüber 2 s erniedrigt. Bei einer Verkürzung der Inspirationszeit von 2 auf 1 s kam es nur bei einem UÖSD von 0,49 kPa (5 cmH2O) zu einer Magenbeatmung.

Schlussfolgerung

In diesem Simulationsmodell eines Lungengesunden mit ungeschütztem Atemweg führte eine von 2 auf 1 s reduzierte Inspirationszeit bei Anwendung des Smart-Bag® zu vergleichbaren inspiratorischen Spitzendrücken und erniedrigten, aber klinisch vergleichbaren Lungentidalvolumina. Eine Magenbeatmung trat nur bei einem UÖSD von 0,49 kPa (5 cmH2O) auf und war bei einer Beatmungszeit von 2 s höher als bei 1 s.

Abstract

Background

Currently 30 chest compressions and 2 ventilations with an inspiratory time of 1 s are recommended during cardiopulmonary resuscitation with an unprotected airway, thus spending about 15% instead of 40% of resuscitation time on ventilation. Time could be gained for chest compressions when reducing inspiratory time from 2 s to 1 s, however, stomach inflation may increase as well.

Methods

In an established bench model we evaluated the effect of reducing inspiratory time from 2 s to 1 s at different lower oesophageal sphincter pressure (LOSP) levels using a novel peak inspiratory-flow and peak airway-pressure-limiting bag-valve-mask device (Smart-Bag™).

Results

A reduction of inspiratory time from 2 s to 1 s resulted in significantly lower peak airway pressure with LOSP of 0.49 kPa (5 cmH2O), 0.98 kPa (10 cmH2O) and 1.47 kPa (15 cmH2O) and an increase with 1.96 kPa (20 cmH2O). Lung tidal volume was reduced with 1 s compared to 2 s. When reducing inspiratory time from 2 s to 1 s, stomach inflation occurred only at a LOSP of 0.49 kPa (5 cmH2O).

Conclusions

In this model of a simulated unprotected airway, a reduction of inspiratory time from 2 s to 1 s using the Smart-Bag™ resulted in comparable inspiratory peak airway pressure and lower, but clinically comparable, lung tidal volume. Stomach inflation occurred only at a LOSP of 0.49 kPa (5 cmH2O), and was higher with an inspiratory time of 2 s vs 1 s.

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Danksagung

Diese Studie wurde durch die Österreichische Nationalbank, Projekt Nr. 9513 und 11448, Wien, Österreich, unterstützt.

Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

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Authors and Affiliations

  1. Univ.-Klinik für Anaesthesie und Allgemeine Intensivmedizin, Medizinische Universität, Anichstrasse 35, 6020, Innsbruck, Österreich

    A. von Goedecke M. Sc., P. Paal, C. Keller, W. G. Voelckel, H. Herff, K. H. Lindner & V. Wenzel

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  1. A. von Goedecke M. Sc.
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  2. P. Paal
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  3. C. Keller
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  4. W. G. Voelckel
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  5. H. Herff
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  6. K. H. Lindner
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  7. V. Wenzel
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Correspondence to A. von Goedecke M. Sc..

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von Goedecke, A., Paal, P., Keller, C. et al. Beatmung eines ungeschützten Atemwegs. Anaesthesist 55, 629–634 (2006). https://doi.org/10.1007/s00101-006-1013-8

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  • DOI: https://doi.org/10.1007/s00101-006-1013-8

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