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Nichtinvasive Beatmung bei Patienten mit Lungenödem und akuter respiratorischer Insuffizienz

Noninvasive ventilation in patients with pulmonary oedema and acute respiratory insufficiency

  • Leitthema
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Der Pneumologe Aims and scope

Zusammenfassung

Nichtinvasive Beatmung (NIV) wird mit zunehmender Häufigkeit bei Patienten mit akuter respiratorischer Insuffizienz eingesetzt. Ziel ist die mechanische Unterstützung der Ventilation und damit eine Verbesserung der Oxygenierung, eine Reduktion der Hyperkapnie und die Korrektur einer respiratorischen Azidose. NIV wird bei Patienten mit akuter Linksherzinsuffizienz und kardial bedingtem Lungenödem mit gutem Erfolg angewendet. Sowohl „continuous positive airway pressure“ (CPAP) als auch die Beatmungsmodi „pressure controlled ventilation“ (PCV) und „pressure support ventilation“ (PSV) gelten heute beim akuten Lungenödem als „evidence based“ Therapiestandard. Die Erfolgsrate einer primär eingesetzten NIV liegt bei diesen Patienten zwischen 60 und 75%. Prädiktoren für das Versagen der NIV-Therapie, die dann durch endotracheale Intubation ersetzt werden muss, sind ein fortgeschritteneres Krankheitsstadium, verminderte Vigilanz, niedriger pH, nicht beherrschbare Luftleckagen im Bereich der Maske, massives Sekretaufkommen und eine Pneumonie.

Abstract

Noninvasive ventilation (NIV) is increasingly used in patients with acute respiratory insufficiency. NIV might mechanically support the ventilation of the patient and might therefore improve oxygenation, decrease hypercapnia, and correct respiratory acidosis. NIV has been successfully applied in patients with respiratory insufficiency due to acute cardiogenic pulmonary oedema. There is sufficient scientific evidence to use CPAP or bilevel ventilatory modes (pressure controlled ventilation, pressure support ventilation) as first-line treatment in these patients. The success rate of NIV is 60–75%. Predictors of NIV failure include greater severity of the underlying illness, lower level of consciousness, lower pH; more air leak around the mask, greater quantity of secretions, and the presence of pneumonia.

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  1. Abteilung Pneumologie, Medizinische Hochschule Hannover

    T. Köhnlein & T. Welte

  2. Abteilung Pneumologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625 , Hannover

    T. Köhnlein

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  1. T. Köhnlein
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  2. T. Welte
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Correspondence to T. Köhnlein.

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Köhnlein, T., Welte, T. Nichtinvasive Beatmung bei Patienten mit Lungenödem und akuter respiratorischer Insuffizienz. Pneumologe 2, 339–347 (2005). https://doi.org/10.1007/s10405-005-0058-8

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