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Protektive Beatmungstherapie

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Protective ventilation therapy

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Zusammenfassung

Die mechanische Beatmung ist eine etablierte Methode in der Behandlung der respiratorischen Insuffizienz und ermöglicht die Sicherstellung der Ventilation und Oxygenierung während einer Allgemeinanästhesie. Allgemeinanästhesie und mechanische Beatmung führen zu relevanten Veränderungen der Ventilation, der pulmonalen Perfusion und des Gasaustausches. Verfahrensbedingt sind mit der mechanischen Beatmung Risiken verbunden. Ein Risiko in der Behandlung von Patienten stellt der beatmungsassoziierte Lungenschaden dar. Bei Patienten mit akutem Lungenversagen konnten durch die Anwendung einer lungenprotektiven Beatmungsstrategie (Tidalvolumenreduktion und Limitierung des Beatmungsplateaudrucks) die Aktivität von Inflammationsmediatoren, die Beatmungsdauer und der Endpunkt Mortalität positiv beeinflusst werden. Es existieren experimentelle Hinweise, dass die mechanische Beatmung von gesunden Lungen gleichfalls Lungenschäden induziert; die klinische Relevanz dieser experimentellen Ergebnisse ist derzeit unklar. Klinische Studien, die eine konventionelle Beatmung mit einer protektiven Beatmung während Allgemeinanästhesie auf den Endpunkt pulmonale Inflammation verglichen haben, erbrachten inkonsistente Ergebnisse. Es existieren keine klinischen Daten, die zeigen, dass die Translation des protektiven Beatmungskonzepts von Patienten mit akutem Lungenversagen auf die Beatmung lungengesunder Patienten zu einem Vorteil hinsichtlich der Morbidität und Mortalität führt. Die Frage nach der optimalen protektiven mechanischen Beatmung bei lungengesunden Patienten bleibt damit unbeantwortet.

Abstract

General anesthesia and mechanical ventilation affect gas exchange, ventilation and pulmonary perfusion and there is an increasing body of evidence that mechanical ventilation itself promotes lung injury. Lung protective mechanical ventilation in patients suffering from acute lung injury or acute respiratory distress syndrome by means of reduced tidal volumes and limited plateau pressures has been shown to result in reduction of systemic inflammatory mediators, increased ventilator-free days and reduction in mortality. Experimental studies suggest that mechanical ventilation of uninjured lungs may also induce lung damage; however, the clinical relevance remains unknown. Human prospective studies comparing mechanical ventilation strategies during general anesthesia have shown inconsistent results with respect to inflammatory mediators. There is a lack of clinical evidence that lung protective ventilation strategies as used in patients with lung injury may improve clinical outcome of patients with uninjured lungs. The question of which ventilatory strategy will best protect normal human lungs remains unanswered.

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  1. Klinik für Anästhesiologie, Universitätsmedizin Mainz der Johannes Gutenberg-Universität, Langenbeckstr. 1, 55131, Mainz, Deutschland

    M. David, M. Bodenstein & K. Markstaller

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  1. M. David
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David, M., Bodenstein, M. & Markstaller, K. Protektive Beatmungstherapie. Anaesthesist 59, 595–606 (2010). https://doi.org/10.1007/s00101-010-1743-5

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