Abstract
Numerous animal experiments and clinical studies showed aggressive ventilation to injure the lungs. This led to the concept of protective ventilation, which includes the use of low tidal volumes, application of higher PEEP-levels as well as early spontaneous breathing efforts. Ventilation of patients with ALI and ARDS needs a concise ventilation and weaning concept and its transmission into reality must be controlled. Newer ventilation methods like high frequency oscillatory ventilation and small pumpless or miniaturized pump-driven extracorporal lungassist devices can be used as rescue therapy. So far these have not shown a reduction of mortality in clinical trials. This review focuses on the recent advances and newer ventilation techniques and their contribution to treatment of patients with ALI and ARDS.
Zusammenfassung
Zahllose tierexperimentelle und klinische Erkenntnisse beweisen, dass aggressive Beatmung eine progrediente Schädigung der Lunge bewirken kann. Dies führte zu dem Konzept der protektiven Beatmung, die die Anwendung von kleinen Atemzugvolumina, die Applikation eines höheren PEEP sowie frühzeitige Spontanatmung umfasst. Die Beatmung von Patienten mit einer akuten Schädigung der Lunge erfordert für jeden Patienten ein klar strukturiertes Beatmungs- und Weaningkonzept, dessen Umsetzung in die Realität täglich überprüft werden muss. Neuere Beatmungsmethoden, wie die Hochfrequenz-Oszillation-Ventilation und die miniaturisierten, einfacher zu handhabenden extra-korporalen Gasaustausch-Systeme, können aktuell als Rescuetherapie genutzt werden; eine Reduktion der Mortalität ist bislang in Studien nicht belegt. Die Anwendung von NAVA erlaubt möglicherweise eine bessere Anpassung an den physiologischen Bedarf des Patienten und optimiert die Synchronizität. Als Fazit lässt sich subsumieren, dass mechanische Beatmung so schonend wie möglich mit niedrigst möglichem Spitzendruck, Druckamplitude, Atemzugvolumen und Flow sein sollte, sowie so physiologisch wie möglich ggfs. unter Zuhilfenahme von NAVA.
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Abbreviations
- Abb.:
-
Abbildung
- ALI:
-
acute lung injury
- ARDS:
-
acute respiratory distress syndrome
- COPD:
-
chronisch obstruktive Lungenerkrankung
- ECMO:
-
extracorporale Membranoxygenierung
- FiO2 :
-
Fraktion inspiratorischen Sauerstoffs
- ggfs.:
-
gegebenenfalls
- HFOV:
-
Hochfrequenz Oszillationsventilation
- HZV:
-
Herzzeitvolumen
- iLA:
-
interventional lungassist (vormals
- PECLA:
-
pumpless extracorporal lungassist)
- iNO:
-
inhalatives Stickstoffmonoxid
- KI:
-
Kontraindikationen
- min:
-
minimal
- mPAW:
-
Atemwegsmitteldruck
- NAVA:
-
neurally adjusted ventilatory assist
- NIPPV:
-
noninvasive positive pressure ventilation
- NIV:
-
noninvasive ventilation
- NPV:
-
negative pressure ventilation
- PaO2 :
-
arterieller Sauerstoffpartialdruck
- PEEP:
-
positiver endexspiratorischer Druck
- PFC:
-
Perflourcarbone
- PLV:
-
partial liquid ventilation
- TLV:
-
total liquid ventilation
- TV:
-
Tidalvolumen
- v. a.:
-
vor allem
- z. B.:
-
zum Beispiel
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Serie:
Neue Technologien in der Intensivmedizin
Herausgegeben von J. Langgartner (Regensburg) und R.M. Schmid (München)
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Lubnow, M., Karagiannidis, C., Pfeifer, M. et al. Sinnvoller Einsatz neuer Beatmungstechniken bei akutem Lungenversagen. Intensivmed 45, 476–488 (2008). https://doi.org/10.1007/s00390-008-0912-0
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DOI: https://doi.org/10.1007/s00390-008-0912-0