Nichtinvasive Beatmung in der Notaufnahme

Non-invasive positive pressure ventilation in the emergency department

Zusammenfassung

Patienten mit dem Leitsymptom Luftnot oder der Diagnose einer akuten respiratorischen Insuffizienz (ARI) sind Hochrisikopatienten, die häufig in Notaufnahmen vorgestellt werden. Die Möglichkeit zur und die Kompetenz in der Durchführung einer nichtinvasiven Beatmung (NIV) in der Notaufnahme sind für diese Patienten ein positiver Prädiktor für den Krankheitsverlauf. Neben den Indikationen zur NIV bei zunächst häufig noch unklaren Krankheitsentitäten werden in diesem Artikel auch strukturelle und technische Aspekte fokussiert, um die Vorteile, aber auch Grenzen der NIV im Notaufnahmesetting darzustellen.

Abstract

Patients with the chief complaint of dyspnea or the diagnosis of acute respiratory insufficiency (ARI) are high risk patients who are often presented at emergency departments. In these cases, the possibility for and competence in carrying out non-invasive ventilation (NIV) in the emergency department represents the main predictor for a successful outcome for these patients. In addition to the indications for NIV with often still unclear disease entities, this article focusses on structural and technical aspects in order to present the advantages as well as the limitations of NIV in the adult emergency setting.

This is a preview of subscription content, log in to check access.

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. 1.

    Agarwal R, Reddy C, Aggarwal AN, Gupta D (2006) Is there a role for noninvasive ventilation in acute respiratory distress syndrome? A meta-analysis. Respir Med 100(12):2235–2238

    Article  PubMed  Google Scholar 

  2. 2.

    Antonelli M, Conti G, Esquinas A et al (2007) A multiple-center survey on the use in clinical practice of noninvasive ventilation as a first-line intervention for acute respiratory distress syndrome. Crit Care Med 35(1):18–25

    Article  PubMed  Google Scholar 

  3. 3.

    Andreu-Ballester JC, Almela-Quilis A, Cano-Cano MJ et al (2010) Use of non-invasive positive pressure ventilation in emergency departments of hospitals in Spain. Emerg Med J 27(8):619–620

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Antro C, Merico F, Urbino R, Gai V (2005) Non-invasive ventilation as a first-line treatment for acute respiratory failure: “real life” experience in the emergency department. Emerg Med J 22(11):772–777

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Azoulay É, Demoule A, Jaber S et al (2011) Palliative noninvasive ventilation in patients with acute respiratory failure. Intensive Care Med 37(8):1250–1257

    Article  PubMed  Google Scholar 

  6. 6.

    Baillard C, Fosse JP, Sebbane M et al (2006) Noninvasive ventilation improves preoxygenation before intubation of hypoxic patients. Am J Respir Crit Care Med 174(2):171–177

    Article  PubMed  Google Scholar 

  7. 7.

    Bernhard M, Bein B, Böttiger BW et al (2015) Handlungsempfehlung zur prähospitalen Notfallnarkose beim Erwachsenen. Notfallmed Up2date 10(02):185–208. https://doi.org/10.1055/s-0033-1358144

    Article  Google Scholar 

  8. 8.

    Bräunlich J, Seyfarth HJ, Wirth H (2015) Nasal High-flow versus non-invasive ventilation in stable hypercapnic COPD: a preliminary report. Multidiscip Respir Med 10(1):27

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Browning J, Atwood B, Gray A (2006) Use of non-invasive ventilation in UK emergency departments. Emerg Med J 23(12):920–921

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Cabrini L, Landoni G, Oriani A et al (2015) Noninvasive ventilation and survival in acute care settings: a comprehensive systematic review and metaanalysis of randomized controlled trials. Crit Care Med 43(4):880–888

    Article  PubMed  Google Scholar 

  11. 11.

    Carson KV, Usmani ZA, Smith BJ (2014) Noninvasive ventilation in acute severe asthma: current evidence and future perspectives. Curr Opin Pulm Med 20(1):118–123

    Article  PubMed  Google Scholar 

  12. 12.

    Chevrolet JC, Jolliet P, Abajo B et al (1991) Nasal positive pressure ventilation in patients with acute respiratory failure. Difficult and time-consuming procedure for nurses. Chest 100(3):775–782

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Chiumello D, Coppola S, Froio S et al (2013) Noninvasive ventilation in chest trauma: systematic review and meta-analysis. Intensive Care Med 39(7):1171–1180

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Chung LP, Winship P, Phung S et al (2010) Five-year outcome in COPD patients after their first episode of acute exacerbation treated with non-invasive ventilation. Respirology 15(7):1084–1091

    Article  PubMed  Google Scholar 

  15. 15.

    Curtis JR, Cook DJ, Sinuff T et al (2007) Noninvasive positive pressure ventilation in critical and palliative care settings: understanding the goals of therapy. Crit Care Med 35(3):932–939

    Article  PubMed  Google Scholar 

  16. 16.

    Delay JM, Sebbane M, Jung B et al (2008) The effectiveness of noninvasive positive pressure ventilation to enhance preoxygenation in morbidly obese patients: a randomized controlled study. Anesth Analg 107(5):1707–1713

    Article  PubMed  Google Scholar 

  17. 17.

    Dormann H, Wolf M (2015) Nicht invasive Beatmung (NIV) im Notarzteinsatz und in der Notaufnahme. Notarzt 31(05):256–267

    Article  Google Scholar 

  18. 18.

    El-Khatib MF, Esquinas AM, Zeinelddine SM et al (2017) Noninvasive ventilation in the emergency department: insights on implementation bias and evidence. Intern Emerg Med 12(3):417–418

    Article  PubMed  Google Scholar 

  19. 19.

    El-Khatib MF, Kazzi AN, Zeinelddine SM et al (2014) Use of noninvasive positive pressure ventilation in emergency departments of public and private hospitals in Lebanon. Eur J Emerg Med 21(3):230–232

    Article  PubMed  Google Scholar 

  20. 20.

    Frat JP, Thille AW, Mercat A et al (2015) High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med 372(23):2185–2196

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Futier E, Concstantin JM, Pelosi P et al (2011) Noninvasive ventilation and alveolar recruitment maneuver improve respiratory function during and after intubation of morbidly obese patients: a randomized controlled study. Anesthesiology 114(6):1354–1363

    Article  PubMed  Google Scholar 

  22. 22.

    Galindo-Filho VC, Brandão DC, de Cássia RSF et al (2013) Noninvasive ventilation coupled with nebulization during asthma crises: a randomized controlled trial. Respir Care 58(2):241–249

    Article  PubMed  Google Scholar 

  23. 23.

    Ganesh A, Shenoy S, Doshi V et al (2015) Use of Noninvasive ventilation in adult patients with acute asthma exacerbation. Am J Ther 22(6):431–434

    Article  PubMed  Google Scholar 

  24. 24.

    Goodacre S, Stevens JW, Pandor A et al (2014) Prehospital noninvasive ventilation for acute respiratory failure: systematic review, network meta-analysis, and individual patient data meta-analysis. Acad Emerg Med 21(9):960–970

    Article  PubMed  Google Scholar 

  25. 25.

    Gray A, Goodacre S, Newby DE et al (2008) Noninvasive ventilation in acute cardiogenic pulmonary edema. N Engl J Med 359(2):142–151

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Gupta D, Nath A, Agarwal R, Behera D (2010) A prospective randomized controlled trial on the efficacy of noninvasive ventilation in severe acute asthma. Respir Care 55(5):536–543

    PubMed  Google Scholar 

  27. 27.

    Hernández G, Roca O, Colinas L (2017) High-flow nasal cannula support therapy: new insights and improving performance. Crit Care 21(1):62

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Horvath CM, Brutsche MH, Schoch OD et al (2016) NIV by an interdisciplinary respiratory care team in severe respiratory failure in the emergency department limited to day time hours. Intern Emerg Med. https://doi.org/10.1007/s11739-016-1546-z

    PubMed  Google Scholar 

  29. 29.

    Huang HB, Xu B, Liu GY et al (2017) Use of noninvasive ventilation in immunocompromised patients with acute respiratory failure: a systematic review and meta-analysis. Crit Care 21(1):4

    Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Johnson CS, Frei CR, Metersky ML et al (2014) Non-invasive mechanical ventilation and mortality in elderly immunocompromised patients hospitalized with pneumonia: a retrospective cohort study. BMC Pulm Med 14(1):7

    Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    Kumle B, Merz S, Hauschel M et al (2015) Umgang mit Notfallrespiratoren. Notfallmed Up2date 10(03):213–221

    Article  Google Scholar 

  32. 32.

    Meduri GU, Conoscenti CC, Menashe P, Nair S (1989) Noninvasive face mask ventilation in patients with acute respiratory failure. Chest 95(4):865–870

    CAS  Article  PubMed  Google Scholar 

  33. 33.

    Meduri GU, Abou-Shala N, Fox RC et al (1991) Noninvasive face mask mechanical ventilation in patients with acute hypercapnic respiratory failure. Chest 100(2):445–454

    CAS  Article  PubMed  Google Scholar 

  34. 34.

    Monro-Somerville T, Sim M, Ruddy J et al (2017) The effect of high-flow nasal cannula oxygen therapy on mortality and intubation rate in acute respiratory failure: a systematic review and meta-analysis. Crit Care Med 45(4):e449–e456

    Article  PubMed  Google Scholar 

  35. 35.

    Nava S, Ferrer M, Esquinas A et al (2013) Palliative use of non-invasive ventilation in end-of-life patients with solid tumours: a randomised feasibility trial. Lancet Oncol 14(3):219–227

    Article  PubMed  Google Scholar 

  36. 36.

    Nouira S, Boukef R, Bouida W et al (2011) Non-invasive pressure support ventilation and CPAP in cardiogenic pulmonary edema: a multicenter randomized study in the emergency department. Intensive Care Med 37(2):249–256

    Article  PubMed  Google Scholar 

  37. 37.

    Pollack CV, Fleisch KB, Dowsey K (1995) Treatment of acute bronchospasm with β‑adrenergic agonist aerosols delivered by a nasal bilevel positive airway pressure circuit. Ann Emerg Med 26(5):552–557

    Article  PubMed  Google Scholar 

  38. 38.

    Roberts S, Skinner D, Biccard B, Rodseth RN (2014) The role of non-invasive ventilation in blunt chest trauma: systematic review and meta-analysis. Eur J Trauma Emerg Surg 40(5):553–559

    CAS  Article  PubMed  Google Scholar 

  39. 39.

    Schwabbauer N et al (2014) Nasal high-flow oxygen therapy in patients with hypoxic respiratory failure: effect on functional and subjective respiratory parameters compared to conventional oxygen therapy and non-invasive ventilation (NIV). BMC Anesthesiol 14(1):66

    Article  PubMed  PubMed Central  Google Scholar 

  40. 40.

    Shameem M, Bhargava R, Ahmad Z (2005) Identification of preadmission predictors of outcome of noninvasive ventilation in acute exacerbation of chronic obstructive pulmonary disease. Indian J Crit Care Med 9(4):200

    Article  Google Scholar 

  41. 41.

    Soma T, Hino M, Kida K, Kudoh S (2008) A prospective and randomized study for improvement of acute asthma by non-invasive positive pressure ventilation (NPPV). J Intern Med 47(6):493–501

    Article  Google Scholar 

  42. 42.

    Spoletini G, Hill NS (2016) High-flow nasal oxygen versus noninvasive ventilation for hypoxemic respiratory failure: do we know enough? Ann Thorac Med 11(3):163

    Article  PubMed  PubMed Central  Google Scholar 

  43. 43.

    Sweet DD, Naismith A, Keenan SP et al (2008) Missed opportunities for noninvasive positive pressure ventilation: a utilization review. J Crit Care 23(1):111–117

    Article  PubMed  Google Scholar 

  44. 44.

    Timmermann A, Byhahn C, Wenzel V et al (2012) Handlungsempfehlung für das präklinische Atemwegsmanagement. Notfallmed Up2date 7(02):105–120

    Article  Google Scholar 

  45. 45.

    Titlestad IL, Lassen AT, Vestbo J (2013) Long-term survival for COPD patients receiving noninvasive ventilation for acute respiratory failure. Int J Chron Obstruct Pulmon Dis 8:215

    Article  PubMed  PubMed Central  Google Scholar 

  46. 46.

    Tomii K, Seo R, Tachikawa R et al (2009) Impact of noninvasive ventilation (NIV) trial for various types of acute respiratory failure in the emergency department; decreased mortality and use of the ICU. Respir Med 103(1):67–73

    Article  PubMed  Google Scholar 

  47. 47.

    Vanpee D (2003) The use of non-invasive ventilation in the emergency department. Eur J Emerg Med 10:77–78

    Article  PubMed  Google Scholar 

  48. 48.

    Vital FM, Saconato H, Ladeira MT et al (2008) Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary edema. Cochrane Libr. https://doi.org/10.1002/14651858.CD005351.pub3

    Google Scholar 

  49. 49.

    Vogelsinger H, Halank M, Wilkens H et al (2013) Highflow-Sauerstoffttherapie bei hyperkapnischen COPD-Patienten: optimiertes Sauerstoffangebot-Daten aus der STIT-2-Studie. Pneumologie 67(05):40

    Article  Google Scholar 

  50. 50.

    Weng CL, Zhao YT, Liu QH et al (2010) Meta-analysis: noninvasive ventilation in acute cardiogenic pulmonary edema. Ann Intern Med 152(9):590–600

    Article  PubMed  Google Scholar 

  51. 51.

    Westhoff M, Schönhofer B, Neumann P et al (2015) Nicht-invasive Beatmung als Therapie der akuten respiratorischen Insuffizienz. Pneumologie 69(12):719–756

    CAS  Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Prof. Dr. H. Dormann.

Ethics declarations

Interessenkonflikt

H. Dormann und S. Lödel geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben. Im Fall von nichtmündigen Patienten liegt die Einwilligung eines Erziehungsberechtigten oder des gesetzlich bestellten Betreuers vor.

Additional information

Redaktion

H. Dormann, Fürth

T. Nicolai, München

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Dormann, H., Lödel, S. Nichtinvasive Beatmung in der Notaufnahme. Notfall Rettungsmed 20, 658–667 (2017). https://doi.org/10.1007/s10049-017-0367-6

Download citation

Schlüsselwörter

  • Nicht invasive Beatmung (NIV)
  • Notaufnahme
  • High-flow-Oxygenierung
  • Akute respiratorische Insuffizienz (ARI)
  • Luftnot

Keywords

  • Non-invasive ventilation (NIV)
  • Emergency department
  • High-flow-oxygen therapy
  • Acute respiratory insufficiency (ARI)
  • Dyspnea