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Nichtinvasive und invasive außerklinische Beatmung beim chronisch respiratorischen Versagen

Konsensus-Report des Arbeitskreises für Beatmung & Intensivmedizin der Österreichischen Gesellschaft für Pneumologie

Non-invasive and invasive out of hospital ventilation in chronic respiratory failure

Consensus report of the working group on ventilation and intensive care medicine of the Austrian Society of Pneumology

Zusammenfassung

Der vorliegende Konsensusreport, der unter der Patronanz der Österreichischen Gesellschaft für Pneumologie (ÖGP) erstellt wurde, soll einen praxisnahen Leitfaden für die außerklinische Beatmung darstellen mit Bedachtnahme auf die spezifisch österreichischen Rahmenbedingungen und gesetzlichen Grundlagen. Der Leitfaden orientiert sich nach einer Konsensusempfehlung der ÖGP zur Ausstattung deslangzeitbeatmeten Patienten aus dem Jahr 2004 und der S2-Leitlinie der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin über die nichtinvasive und invasive Beatmung bei der chronischen respiratorischen Insuffizienz aus 2010, angepasst an nationale Erfahrungen und aktualisiert durch rezente Literatur.

In 11 Kapiteln wird einerseits die Einleitung, Umstellung und Kontrolle der außerklinische Beatmung, die technische Ausstattung sowie der Beatmungszugang, andererseits die verschiedenen Indikationen wie chronisch obstruktive Atemwegserkrankungen, thorakal-restriktive und neuromuskuläre Erkrankungen, das Adipositas-Hypoventilationssyndrom sowie pädiatrische Erkrankungen beschrieben. Weiters wird ausführlich auf die Atemphysiotherapie bei Erwachsenen und Kindern unter invasiver und nichtinvasiver Langzeitbeatmung eingegangen.

Abstract

The current consensus report was compiled under the patronage of the Austrian Society of Pneumology (Österreichischen Gesellschaft für Pneumologie, ÖGP) with the intention of providing practical guidelines for out-of-hospital ventilation that are in accordance with specific Austrian framework parameters and legal foundations. The guidelines are oriented toward a 2004 consensus ÖGP recommendation concerning the setup of long-term ventilated patients and the 2010 German Respiratory Society S2 guidelines on noninvasive and invasive ventilation of chronic respiratory insufficiency, adapted to national experiences and updated according to recent literature. In 11 chapters, the initiation, adjustment, and monitoring of out-of-hospital ventilation is described, as is the technical equipment and airway access. Additionally, the different indications—such as chronic obstructive pulmonary diseases, thoracic restrictive and neuromuscular diseases, obesity hypoventilation syndrome, and pediatric diseases—are discussed. Furthermore, the respiratory physiotherapy of adults and children on invasive and noninvasive long-term ventilation is addressed in detail.

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Abbreviations

ASVG:

Allgemeines Sozialversicherungsgesetz

APT:

Atemphysiotherapie

CO2 :

Kohlendioxid

COPD:

chronic obstructive pulmonary disease (chronisch obstruktive Lungenerkrankung)

EMG:

Elektromyografie

FiO2 :

Fraction of inspired oxygen

FVC:

forcierte Vitalkapazität

GOLD:

Global Initiative for Chronic Obstruvtive Lung Disease

GuKG:

Gesundheits- und Krankenpflegegesetz

HME:

heat and moisture exchanger (Wärme- und Feuchtigkeitsaustauscher)

I:E:

Verhältnis von Inspirations- zu Expirationsdauer

mbar:

millibar

MI:E:

mechanical in-exsufflator

NIV:

noninvasive ventilation (nichtinvasive Beatmung)

NME:

neuromuskuläre Erkrankung

ÖGP:

Österreichische Gesellschaft für Pneumologie

OSAS:

obstruktives Schlafapnoesyndrom

PaCO2 :

arterieller Kohlendioxidpartialdruck

PaO2 :

arterieller Sauerstoffpartialdruck

PCF:

peak cough flow (Hustenspitzenfluss)

PEEP:

positive endexpiratory pressure (positiver endexspiratorischer Druck)

Pe max:

maximaler expiratorischer Druck

Pi max:

maximaler inspiratorischer Druck

PSV:

pressure support ventilation

PTcCO2 :

transkutan gemessener, zur Temperatur korrigierter, Kohlendioxidpartialdruck

PVC:

Polyvinyl-Chlorid

QoL:

quality of life

REM:

rapid eye movement (schnelle Augenbewegungen)

Tbc:

Tuberkulose

VC:

vital capacity (Vitalkapazität)

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P. Schenk – Referentenhonorar: Boehringer Ingelheim, AstraZeneca, Menarini, InterMune, Takeda, Actelion, Torrex-Chiesi, Linde, Maquet, Novartis; Roche; Advisory Board: Boehringer Ingelheim, Torrex-Chiesi, Actelion, Novartis; Research grants: INOTherapeutics, Lilly, AstraZeneca, Roche; Konsulenten-Tätigkeit: Angelini. Aktien- oder sonstiger Besitz an pharmazeutischen bzw. medizintechnischen Unternehmen, Patentrechte etc.: keine.

E. Eber – Referentenhonorar: Honorare von Abbott, AOP Orphan Pharmaceuticals, AstraZeneca, Chiesi, MSD, Novartis, Nycomed; Advisory Board: Mitwirkung in Advisory Boards von AOP Orphan Pharmaceuticals, GSK; Research grants: keine; Konsulenten-Tätigkeit: AOP Orphan Pharmaceuticals; Aktien- oder sonstiger Besitz an pharmazeutischen bzw. medizintechnischen Unternehmen, Patentrechte etc.: keine.

G.C. Funk – Referentenhonorar: Orion Pharma, Actelion, B. Braun, Pfizer, Boehringer Ingelheim, Nycomed, Roche Diagnostics, Dräger, Fresenius; Advisory Board: Takeda Pharma; Research grants: keine; Konsulenten-Tätigkeit: keine; Aktien- oder sonstiger Besitz an pharmazeutischen bzw. medizintechnischen Unternehmen, Patentrechte etc.: keine.

W. Fritz – Referentenhonorar: Astra Zeneca, Bayer, Boehringer Ingelheim, Pfizer, Novartis; Advisory Board: nein; Research grants: nein; Konsulenten-Tätigkeit: nein; Aktien- oder sonstiger Besitz an pharmazeutischen bzw. medizintechnischen Unternehmen, Patentrechte etc.: nein.

S. Hartl – Referentenhonorar: Takeda, Boehringer, GSK; Advisory Board: Böhringer, Takeda, Chiesi, Mundipharma, GSK, Teva, Novartis, Almirall; Research grants: Boehringer, GSK, Novartis, MSD, Astra, als Ludwig Boltzmann Institut; Konsulenten-Tätigkeit: keine; Aktien- oder sonstiger Besitz an pharmazeutischen bzw. medizintechnischen Unternehmen, Patentrechte etc.: keine.

P. Heininger – Referentenhonorar: Fa.: Actelion, GSK, AOP Orphan, Pfizer; Advisory Board: nein; Research grants: nein; Konsulenten-Tätigkeit: nein; Aktien- oder sonstiger Besitz an pharmazeutischen bzw. medizintechnischen Unternehmen, Patentrechte etc.: nein.

E. Kink – Referentenhonorar: Dräger, Habel, Vivisol, Cardinal Health, Menarini; Advisory Board: nein; Research grants: nein; Konsulenten-Tätigkeit: nein; Aktien- oder sonstiger Besitz an pharmazeutischen bzw. medizintechnischen Unternehmen, Patentrechte etc.: nein.

G. Kühteubl – Referentenhonorar: Fa.Habel; Advisory Board: nein; Research grants: nein; Konsulenten-Tätigkeit: nein; Aktien- oder sonstiger Besitz an pharmazeutischen bzw. medizintechnischen Unternehmen, Patentrechte etc.: keine.

B. Oberwaldner – Referentenhonorar: nein; Advisory Board: nein; Research grants: nein; Konsulenten-Tätigkeit: nein; Aktien- oder sonstiger Besitz an pharmazeutischen bzw. medizintechnischen Unternehmen, Patentrechte etc.: nein.

U. Pachernigg – Referentenhonorar: nein; Advisory Board: nein; Research grants: nein; Konsulenten-Tätigkeit: nein; Aktien- oder sonstiger Besitz an pharmazeutischen bzw. medizintechnischen Unternehmen, Patentrechte etc.: nein.

A. Pfleger – Referentenhonorar: keine von Firmen; Advisory Board: nein; Research grants: nein; Konsulenten-Tätigkeit: nein; Aktien- oder sonstiger Besitz an pharmazeutischen bzw. medizintechnischen Unternehmen, Patentrechte etc.: keine.

P. Schandl – Referentenhonorar: Smith Medical Care, Heinen und Löwenstein; Advisory Board: nein; Research grants: nein; Konsulenten-Tätigkeit: nein; Aktien- oder sonstiger Besitz an pharmazeutischen bzw. medizintechnischen Unternehmen, Patentrechte etc.: nein.

I. Schmidt – Referentenhonorar: Air Liquide, Astra Zeneca, Boehringer Ingelheim, Chiesi, Dräger, Forest, Heinen & Löwenstein, Linde, Menarini, Novartis, AOP, Vivisol; Advisory Board: Chiesi; Research grants: nein; Konsulenten-Tätigkeit: nein; Aktien- oder sonstiger Besitz an pharmazeutischen bzw. medizintechnischen Unternehmen, Patentrechte etc.: nein.

M. Stein – Referentenhonorar: Boehringer Ingelheim, Bristol-Myers Squibb, GSK, Habel; Advisory Board: nein; Research grants: nein; Konsulenten-Tätigkeit: nein; Aktien- oder sonstiger Besitz an pharmazeutischen bzw. medizintechnischen Unternehmen, Patentrechte etc.: keine.

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Schenk, P., Eber, E., Funk, GC. et al. Nichtinvasive und invasive außerklinische Beatmung beim chronisch respiratorischen Versagen. Wien Klin Wochenschr 128, 1–36 (2016). https://doi.org/10.1007/s00508-015-0899-z

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Schlüsselwörter

  • Langzeitbeatmung
  • außerklinisch
  • Konsensusempfehlung
  • Respiratorabhängigkeit
  • Atemphysiotherapie

Keywords

  • Long-term ventilation
  • Out-of-hospital
  • Consensus recommendation
  • Respirator dependence
  • Respiratory physiotherapy