Zusammenfassung
Die nichtinvasive Langzeitbeatmung ist eine etablierte Therapie für Patient*innen mit chronisch obstruktiver Lungenerkrankung (COPD) im Endstadium, die an chronisch hyperkapnischer Ateminsuffizienz („chronic hypercapnic respiratory failure“ [CHRF]) leiden. Dies spiegelt sich in ihrer prominenten Stellung innerhalb nationaler und internationaler Richtlinien wider. Die nichtinvasive Beatmung (NIV) kann eingeleitet werden, um die Balance zwischen Belastung und Kapazität der Atempumpe wiederherzustellen und die alveoläre Ventilation zu verbessern. Positive Ergebnisse zur Steigerung der alveolären Ventilation bei COPD(„chronic obstructive pulmonary disease“)-Patient*innen wurden mithilfe der sog. High-intensity-NIV (HI-NIV) erzielt. HI-NIV wurde erstmals 2009 für chronisch hyperkapnische COPD-Patient*innen beschrieben und bezieht sich auf einen spezifischen Beatmungsansatz, bei dem die NIV-Einstellungen darauf abzielen, den Kohlenstoffdioxidpartialdruck maximal zu reduzieren, um durch Erhöhung des inspiratorischen Drucks und der Backupfrequenz eine Normokapnie zu erreichen. Die vergangenen Jahre waren überwiegend davon geprägt, korrekte Therapiemodalitäten zu etablieren und deren Nutzen nachzuweisen. Die Langzeit-NIV bleibt ein aktives Forschungsgebiet, wie die im vergangenen Jahr veröffentlichten europäischen Leitlinien zeigen. Sie zeigen wichtige Zukunftsthemen auf die in großen Studien untersucht werden, wie die Rolle der ambulanten Versorgung, den Nutzen von Telemonitoring und eine klarere pathophysiologische Phänotypisierung des Patientenkollektivs, das von der Therapie profitiert. Dieser Beitrag porträtiert die Entwicklung der nichtinvasiven Langzeitbeatmung bei COPD-Patient*innen und die Inhalte der nationalen und europäischen Leitlinien diesbezüglich.
Abstract
Long-term noninvasive ventilation (NIV) is an established therapy for patients with end-stage chronic obstructive pulmonary disease (COPD) suffering from chronic hypercapnic respiratory failure (CHRF). This is reflected by its prominent position within national and international guidelines. The NIV can be initiated in order to restore the balance between load and capacity of the respiratory pump and to increase alveolar ventilation. Positive results augmenting alveolar ventilation in COPD patients have been achieved by means of high-intensity NIV (HI-NIV). This was first described for chronic hypercapnic COPD patients in 2009 and refers to a specific ventilatory approach whereby NIV settings are aimed at maximum reduction of the partial pressure of carbon dioxide in order to reach normocapnia by increasing inspiratory pressure and back-up frequency. Previous years were predominated by establishing correct therapy modalities and proving their benefits. Long-term NIV remains an active field of research as the European guidelines published last year illustrate by raising questions for the future that need to be answered. They present important future topics that will be assessed in large trials, such as the role of outpatient care, telemonitoring and a clearer pathophysiological phenotyping of the patient collective benefitting from the therapy. This article portrays the development of noninvasive long-term ventilation in COPD patients and the contents of national and European guidelines in this respect.
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M. Wollsching-Strobel, W. Windisch und D.S. Majorski geben an, dass kein Interessenkonflikt besteht.
Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
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C.-P. Criée, Bovenden-Lenglern
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Wollsching-Strobel, M., Windisch, W. & Majorski, D.S. Europäische Leitlinien zur nichtinvasiven Langzeitbeatmung bei chronisch obstruktiver Lungenerkrankung . Pneumologe 18, 13–19 (2021). https://doi.org/10.1007/s10405-020-00355-0
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DOI: https://doi.org/10.1007/s10405-020-00355-0
Schlüsselwörter
- Respiratorische Insuffizienz
- Chronisch hyperkapnische Ateminsuffizienz
- Alveoläre Ventilation
- Nichtinvasive Beatmung
- Normokapnie