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Atemwegsmanagement

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Die Intensivmedizin

Zusammenfassung

Goldstandard zur Sicherung der Atemwege ist die endotracheale Intubation (möglich als orotracheale oder nasotracheale Intubation), mit der eine mechanische Verlegung der Atemwege zuverlässig verhindert oder beseitigt wird. Gleichzeitig eröffnet sie die Möglichkeit, den Patienten an ein Beatmungsgerät anzuschließen und eine positive Druckbeatmung durchzuführen. Sie erleichtert die Bronchialtoilette und erlaubt diagnostische/therapeutische Bronchoskopien sowie die endotracheale Medikamentenapplikation. Die Dilatationstracheotomie ist einer der weltweit häufigsten invasiven Eingriffe auf Intensivstationen. Ziele jeder rechtzeitig innerhalb der Langzeitbeatmung durchgeführten Tracheotomie sind Vermeidung von Kehlkopf- und Stimmbandschäden, schnellere Entwöhnung vom Respirator, bessere Pflege und ein besserer Patientenkomfort. Neben der klassischen chirurgischen Tracheotomie stehen verschiedene Verfahren der perkutanen Tracheotomie zur Verfügung (Ciaglia, Griggs, Fantoni, Frova, Zgoda).

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Literatur

Literatur zu ▶ Abschn. 24.1

  • Adnet F, Baillard C, Borron SW et al (2001a) Randomized study comparing the „sniffing position“ with simple head extension for laryngoscopic view in elective surgery patients. Anesthesiology 95:836–841

    Article  CAS  PubMed  Google Scholar 

  • Adnet F, Borron SW, Dumas JL, Lapostolle F, Cupa M, Lapandry C (2001b) Study of the „sniffing position“ by magnetic resonance imaging. Anesthesiology 94:83–86

    Article  CAS  PubMed  Google Scholar 

  • American Society of Anesthesiologists ASA (2013) Practical Guidelines for Management of the Difficult Airway: An Updated Report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 118:251–270

    Article  Google Scholar 

  • Arné J, Descoins P, Fusciardi J et al (1998) Preoperative assessment of difficult intubation in general and ENT surgery. Br J Anaesth 80:140–146

    Article  PubMed  Google Scholar 

  • Asai T, Shingu K (2004) Difficulty in advancing a tracheal tube over a fiberoptic bronchoscope: incidence, causes and solutions. Br J Anaesth 92:870–881

    Article  CAS  PubMed  Google Scholar 

  • Avrahami E, Frishman E, Spierer I, Englender M, Katz R (1995) CT of minor intubation trauma with clinical correlations. Eur J Radiol 1:68–71

    Article  Google Scholar 

  • Baraka AS, Taha SK, Aoud MT, El-Khatib MF, Kawakabani NI (1999) Preoxygenation: Comparison of maximal breathing and tidal volume breathing techniques. Anesthesiology 91:603–605

    Article  Google Scholar 

  • Benumof JL (1992) Clinical procedures in anesthesia and intensive care. Lippincott, Philadelphia

    Google Scholar 

  • Cheng KC, Hou CC, Huang HC et al (2006) Intravenous injection of methylprednisolone reduces the incidnce of psotextubation stridor in intensive care unite patients. Crit Care Med 34:1345–1350

    Article  CAS  PubMed  Google Scholar 

  • Cook TM, Woodall N, Harper C et al (2011) Major complications of airway management in the UK: results of the Fourth National Audit of the Royal College of Anaesthesists and the Difficult Airway Society. Part 2: Intensive care and emergency departments. Br J Anaesth 106:632–642

    Article  CAS  PubMed  Google Scholar 

  • Cormack RS, Lehane J (1984) Difficult tracheal intubation in obstetrics. Anaesthesia 39:1105–1111

    Article  CAS  PubMed  Google Scholar 

  • Edmark L, Kostova-Aherdan K, Enlund M, Hedenstierna G (2003) Optimal oxygen concentration during induction of general anesthesia. Anesthesiology 98:28–33

    Article  CAS  PubMed  Google Scholar 

  • Folwaczny M, Hickel R (1998) Oro-dentale Verletzungen während der Intubationsnarkose. Anästhesist 47:107–116

    Article  Google Scholar 

  • Hagberg C, Georgi R, Kreir C (2005) Complications of managing the airway. Best Pract Res Clin Anaesthesiol 19:641–659

    Article  PubMed  Google Scholar 

  • Holzapfel I, Chastang C, Demingeon G et al (1999) A randomised study assessing the systematic search for maxillary sinusitis in nasotracheally mechanically ventilated patients: Influence of nosocomial maxillary sinusitis on the occurrence of ventilator-associated pneumonia. Am J Resp Crit Care Med 159:695–701

    Article  CAS  PubMed  Google Scholar 

  • Jaber S, Chanques G, Matecki S et al (2003) Post-extubation stridor in intensive care unit patients. Intensive Care Med 29:69–74

    PubMed  Google Scholar 

  • Jungbauer A, Schumann M, Brunkhorst V et al (2009) Expected difficult tracheal intubation: a prospective comparison of direct laryngoscopy and video laryngoscopy in 200 patients. Br J Anaesth 102:546–550

    Article  CAS  PubMed  Google Scholar 

  • Kambic V, Radsel Z (1978) Intubation lesions of the larynx. Br J Anesth 50:587–590

    Article  CAS  Google Scholar 

  • Kleemann PP (1997) Fiberoptische Intubation: Anwendung fiberendoskopischer Geräte in Anästhesie und Intensivmedizin. Thieme, Stuttgart New York

    Google Scholar 

  • Knill JR (1993) Difficult laryngoscopy nade easy with a „BURP“. Can J Anaesth 40:279–282

    Article  CAS  PubMed  Google Scholar 

  • Krier C, Georgi R (2001) Airway-Management. Thieme, Stuttgart New York

    Google Scholar 

  • Lavery GG, McCloskey BV (2008) The difficult airway in adult critical care. Crit Care Med 36:2163–2173

    Article  PubMed  Google Scholar 

  • Mallampati SR, Gatt SP, Gugino LD et al (1983) A clinical sign to predict difficult tracheal intubation: A prospective study. Can Anaest Soc 32:429–433

    Article  Google Scholar 

  • Marlow TJ, Goltra DD Jr, Schabel SI (1997) Intracranial placement of a nasotracheal tube after facial fracture: a rare complication. J Emerg Med 15:187–191

    Article  CAS  PubMed  Google Scholar 

  • Membership of the Difficult Airway Society Extubation Guidelines Group, Popat M, Mitchell V, Dravid R et al (2012) Difficult Airway Society Guidelines for the management of tracheal extubation. Anaesthesia 67:318–340

    Article  CAS  PubMed  Google Scholar 

  • Mort TC, Waberski BH, Clive J (2009) Extending the preoxygenation period from 4 to 8 mins in critically ill patients undergoing emergency intubation. Crit Care Med 37:68–71

    Article  PubMed  Google Scholar 

  • Naguib M, Scamman FL, O’Sullivan C (2006) Predictive performance of three multivariante difficult tracheal intubation models: A double-blind, case-controlled study. Anest Analg 102:818–824

    Article  Google Scholar 

  • Nimmagadda U, Salem MR, Joseph NJ et al (2000) Efficacy of preoxygenation with tidal volume breathing. Anesthesiology 93:693–698

    Article  CAS  PubMed  Google Scholar 

  • Noppens RR, Leimer S, Eisel N et al (2012) Endotracheal intubation using the C-MACR video laryngoscope or the Macintosh laryngoscope: A prospective, comparative study in the ICU. Crit Care 16:R103

    Article  PubMed Central  PubMed  Google Scholar 

  • Patil VU, Stehling LC, Zauder HL (1983) Predicting the difficulty of intubation utilizing an intubation gauge. Anesthesiol Rev 10:32–33

    Google Scholar 

  • Reynolds SF, Heffner J (2005) Airway management of the critically ill patient: Rapid sequence induction. Chest 127:1397–1412

    Article  PubMed  Google Scholar 

  • Rieger A (2001) Intubationsschäden: Inzidenz, Komplikationen, Konsequenzen. In: Krier C, Georgi R (Hrsg) Airway-Management. Thieme, Stuttgart New York, S 139–153

    Google Scholar 

  • Riou B, Richard C, Rimailho A, Auzepy P (1986) Septicemia following maxillary sinusitis. A rare complication of nasotracheal intubation. Ann Fr Anesth Réanim 5:83–84

    Article  CAS  PubMed  Google Scholar 

  • Steinmann D, Priebe HJ (2009) Krikoiddruck. Anästhesist 58:695–707

    Article  CAS  Google Scholar 

  • Ulrich-Pur H, Hraska F, Krafft P et al (2006) Comparison of mucosal pressures induced by cuffs of different airway devices. Anesthesiology 104:933–938

    Article  PubMed  Google Scholar 

  • Walker L, Brampton W, Halai M et al (2009) Randomized controlle trial of intubation with the McGrath Series 5 videolaryngoscope by inexperienced anaesthetists. Br J of Anaesthesia 103:440–445

    Article  CAS  Google Scholar 

  • Walz JM, Zayaruzny M, Heard SO (2007) Airway Management in Critical Illness. Chest 131:608–620

    Article  PubMed  Google Scholar 

  • Warner ME, Benenfeld SM, Warner MA, Schroeder DR, Maxson PM (1999) Perianesthetic dental injuries: frequency, outcome, and risk factors. Anesthesiology 90:1302–1305

    Article  CAS  PubMed  Google Scholar 

  • Zilles K, Tillmann B (2010) Anatomie. Springer, Berlin Heidelberg New York

    Book  Google Scholar 

Literatur zu ▶ Abschn. 24.2

  • Auzinger G, O’Callaghan GP, Bernal W et al (2007) Percutaneous tracheostomy in patients with severe liver disease and a high incidence of refractory coagulopathy: a prospective trial. Crit Care 11:R110

    Article  PubMed Central  PubMed  Google Scholar 

  • Barquist ES, Amortegui J, Hallal A et al (2006) Tracheostomy in ventilator dependent trauma patients: a prospective, randomized intention-to-treat study. J Trauma 60:91–97

    Article  PubMed  Google Scholar 

  • Bause H, Prause A (1997) Indikationen, Kontraindikationen und Komplikationen der Dilatationstracheotomie nach Ciaglia. In: Deutsche Akademie für anästhesiologische Fortbildung (Hrsg) Aktuelles Wissen für Anästhesisten. Refresher Course. Springer, Berlin Heidelberg New York Tokio, S 155–164

    Google Scholar 

  • Bause H, Prause A, Schulte am Esch J (1995) Indikation und Technik der perkutanen Dilatationstracheotomie für den Intensivpatienten. Anesthesiol Intensivmed Notfallmed Schmerzther 30:492–496

    Article  CAS  Google Scholar 

  • Behl S, Watt JW (2005) Prediction of tracheostomy tube size for paediatric long-term ventilation: an audit of children with spinal cord injury. Br J Anaesth 94:88–91

    Article  CAS  PubMed  Google Scholar 

  • Nun BA, Altman E, Best LA (2005) Extended indications for percutaneous tracheostomy. Ann Thorac Surg 80:1276–1279

    Article  PubMed  Google Scholar 

  • Blot F, Similowski T, Trouillet JL et al (2008) Early tracheotomy versus prolonged endotracheal intubation in unselected severely ill ICU patients. Intensive Care Med 34:1779–1787

    Article  PubMed  Google Scholar 

  • Ciaglia P (1999) Technique, complications, and improvements in percutaneous dilatational tracheostomy. Chest 115:1229–1230

    Article  CAS  PubMed  Google Scholar 

  • Ciaglia P, Firshing R, Syniec C (1985) Elective percutaneous dilatational tracheostomy. Chest 87:715–719

    Article  CAS  PubMed  Google Scholar 

  • Cianchi G, Zagli G, Bonizzoli M et al (2010) Comparison between single-step and balloon dilatational tracheostomy in intensive care unit: a single-centre, randomized controlled study. Br J Anaesth 104:728–732

    Article  CAS  PubMed  Google Scholar 

  • Dennis BM, Eckert MJ, Gunter OL et al (2013) Safety of bedside percutaneous tracheostomy in the critically ill: evaluation of more than 3,000 procedures. J Am Coll Surg 216:865–857

    Article  Google Scholar 

  • Durbin CG, Perkins MP, Moores LK (2010) Should tracheostomy be performed as early as 72 hours in patients requiring prolonged mechanical ventilation? Respir Care 55:76–87

    PubMed  Google Scholar 

  • Fantoni A, Ripamonti D (1997) A non-derivative, non surgical tracheostomy: the translaryngeal method. Intensive Care Med 27:386

    Article  Google Scholar 

  • Fantoni A, Ripamonti D (2002) Tracheostomy in pediatrics patients. Minerva Anestesiol 68:433–442

    CAS  PubMed  Google Scholar 

  • Flum DR, Steinberg SD, Adams PX, Wallak MK (1998) Bedside percutaneous tracheostomy in acquired immunodeficiency syndrome. Am Surg 64:444

    CAS  PubMed  Google Scholar 

  • Frutos-Vivar F, Esteban A, Apezteguia C et al (2005) Outcome of mechanically ventilated patients who require a tracheostomy. Crit Care Med 33:290–298

    Article  PubMed  Google Scholar 

  • Griffiths J, Barber VS, Morgan L et al (2005) Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. BMJ 330:1243

    Article  PubMed Central  PubMed  Google Scholar 

  • Griggs WM, Worthly LIG, Gilligan JE, Thomas PD, Myburg JA (1990) A simple percutaneous tracheostomy technique. Surg Gynecol Obstet 170:543–545

    CAS  PubMed  Google Scholar 

  • Guinot PG, Zogheib E, Petiot S et al (2012) Ultrasound-guided percutaneous tracheostomy in critically ill obese patients. Crit Care 16:R40

    Article  PubMed Central  PubMed  Google Scholar 

  • Hernandez G, Pedrosa A, Ortiz R et al (2013) The effects of increasing effective airway diameter on weaning from mechanical ventilation in tracheostomized patients: a randomized controlled trial. Intensive Care Med 39:1063–1070

    Article  PubMed  Google Scholar 

  • Heuer B, Deller A (1998) Früh- und Spätresultate der perkutanen Dilatationstracheostomie (PDT Ciaglia) bei 195 Intensivpatienten. Anesthesiol Intensivmed Notfallmed Schmerzther 33:306

    Article  CAS  Google Scholar 

  • Jacobs JV, Hill DA, Petersen SR et al (2013) ″Corkscrew stenosis″: defining and preventing a complication of percutaneous dilatational tracheostomy. J Thorac Cardiovasc Surg 145:716–720

    Article  PubMed  Google Scholar 

  • Kluge S, Baumann HJ, Maier C, Klose H, Meyer A, Nierhaus A, Kreymann G (2008) Tracheostomy in the Intensive Care Unit: A Nationwide Survey. Anesth Analg 107:1639–1643

    Article  PubMed  Google Scholar 

  • Kluge S, Meyer A, Kühnelt P, Baumann HJ, Kreymann G (2004) Percutaneous tracheostomy is safe in patients with severe thrombocytopenia. Chest 126(2):547–551

    Article  PubMed  Google Scholar 

  • Kluger Y, Paul DB, Lucke J (1996) Early tracheostomy in trauma patients. Eur J Emerg Med 3:95–101

    Article  CAS  PubMed  Google Scholar 

  • Koch T, Hecker B, Hecker A et al (2012) Early tracheostomy decreases ventilation time but has no impact on mortality of intensive care patients: a randomized study. Langenbeck’s Arch Surg 397:1001–1008

    Article  Google Scholar 

  • Kornblith LZ, Burlew CC, Moore EE et al (2011) One thousand bedside percutaneous tracheostomies in the surgical intensive care unit: time to change the gold standard. J Am Coll Surg 212:163–170

    Article  PubMed  Google Scholar 

  • Kuhl T, Wendt S, Michels G et al (2012) Alternative Punktionstracheotomie mit Hilfe der Larynxmaske. Dtsch Med Wochenschr 137:442–446

    Article  CAS  PubMed  Google Scholar 

  • MacIntyre NR, Cook DJ et al (2001) Evidence-Based Guidelines for Weaning and Discontinuing Ventilatory Support*: A Collective Task Force Facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest 120(6):375S–395S

    Article  CAS  PubMed  Google Scholar 

  • Mansharamani NG, Koziel H, Garland R et al (2001) Safety of bedside percutaneous dilatational tracheostomy in obese patients in the ICU. Chest 117:1426

    Article  Google Scholar 

  • Marelli D, Paul A, Manolidis S et al (1990) Endoscopic guided percutaneous tracheostomy: early results of a consecutive trial. J Trauma 30:433–435

    Article  CAS  PubMed  Google Scholar 

  • Marx WH, Ciaglia P, Graniero KD (1996) Some important Details in the technique of percutaneous dilatational tracheostomy via the modified Seldinger technique. Chest 110:762–766

    Article  CAS  PubMed  Google Scholar 

  • Norwood S, Valina VL, Short K et al (2000) Incidence of tracheal stenosis and other late complications after percutaneous tracheostomy. Ann Surg 232:233

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Plummer AL (1989) Consensus conference on „Artificial airways in patients receiving mechanical ventilation“. Chest 96:178–180

    Article  CAS  PubMed  Google Scholar 

  • Raju A, Joseph DK, Diarra C et al (2010) Percutaneous versus open tracheostomy in the pediatric trauma population. Am Surg 76:276–278

    PubMed  Google Scholar 

  • Rodriguez JL, Steinberg SM, Luchetti FA (1990) Early tracheostomy for primary airway management in the surgical care setting. Surgery 108:655–665

    CAS  PubMed  Google Scholar 

  • Romero CM, Marambio A, Larrondo J et al (2010) Swallowing dysfunction in nonneurologic critically ill patients who require percutaneous dilatational tracheostomy. Chest 137:1278–1282

    Article  PubMed  Google Scholar 

  • Rosenbower TJ, Morris JA, Eddy VA, Ries WR (1998) The long-term complications of percutaneous dilatational tracheostomy. Am Surg 64:82

    CAS  PubMed  Google Scholar 

  • Rumbak MJ, Newton M, Truncale T et al (2004) A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Crit Care Med 32:1689–1694

    Article  PubMed  Google Scholar 

  • Steele AP, Evan HW, Afag MA et al (2000) Long-term follow-up of Griggs percutaneous tracheostoma with spiral CT and questionnaire. Chest 117:1430

    Article  CAS  PubMed  Google Scholar 

  • Terragni PP, Antonelli M, Fumagalli R et al (2010) Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. JAMA; 303:1483–1489

    Article  CAS  PubMed  Google Scholar 

  • Toursarkissian B, Fowler CL, Zweng TN et al (1994a) Percutaneous dilational tracheostomy in children and teenagers. J Pediatr Surg 29:1421–1424

    Article  CAS  PubMed  Google Scholar 

  • Toursarkissian B, Zweng TN, Kearney PA et al (1994b) Percutaneous dilational tracheostomy: report of 141 cases

    Google Scholar 

  • Trouillet JL, Luyt CE, Guiguet M et al (2011) Early percutaneous tracheotomy versus prolonged intubation of mechanically ventilated patients after cardiac surgery: a randomized trial. Ann Intern Med 154:373–383

    Article  PubMed  Google Scholar 

  • Walz MK (2002) Die Tracheostomie: Indikationen, Methoden, Risiken. Anästhesist 51:123–133

    Article  CAS  Google Scholar 

  • Walz MK, Hellinger A, Walz MV, Nimtz K, Peitgen K (1997) Die translaryngeale Tracheostomie. Chirurg 68:531–535

    Article  CAS  PubMed  Google Scholar 

  • Zgoda M, Berger R (2003) Balloon Facilitated Percutaneous Tracheostomy Tube Placement: A Novel Technique. Chest 124(4):130S–131S

    Google Scholar 

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Authors and Affiliations

  1. Klinik für Anästhesie und Operative Intensivmedizin, St. Elisabeth-Krankenhaus, Werthmannstraße 1, 50935, Köln, Deutschland

    Prof. Dr. Fritz Fiedler

  2. Abt. Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie, Asklepios Klinik Altona, Paul-Ehrlich-Str. 1, 22763, Hamburg, Deutschland

    Dr. Axel Prause

  3. Anästhesiologie II - Operative Intensivmedizin, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland

    Univ.-Prof. Dr. Michael Quintel

  4. Chirurgische Klinik, Universitätsklinikum Freiburg, Hugstetter Strasse 49, 79106, Freiburg, Deutschland

    PD Dr. Stefan Utzolino

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  1. Univ.-Prof. Dr. Michael Quintel
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  2. Prof. Dr. Fritz Fiedler
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  3. PD Dr. Stefan Utzolino
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  4. Dr. Axel Prause
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Editor information

Editors and Affiliations

  1. Klinik für Anästhesiologie, RWTH Aachen Universitätsklinikum Aachen, Aachen, Germany

    Gernot Marx

  2. Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lübeck, Germany

    Elke Muhl

  3. Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Goethe-Universität Frankfurt, Frankfurt, Hessen, Germany

    Kai Zacharowski

  4. Medizinische Klinik I, Universitätsklinikum Frankfurt, Frankfurt, Germany

    Stefan Zeuzem

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Quintel, M., Fiedler, F., Utzolino, S., Prause, A. (2015). Atemwegsmanagement. In: Marx, G., Muhl, E., Zacharowski, K., Zeuzem, S. (eds) Die Intensivmedizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54953-3_24

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