Skip to main content
SpringerLink
Log in

Beatmungsstrategien beim schweren therapieresistenten Asthma

  • Conference paper
Das therapieresistente Asthma

Zusammenfassung

Eine Imbalance zwischen Pumpkapazität und Belastung der Atempumpe infolge hochgradig beeinträchtigter Atemmechanik kann bei Patienten im Status asthmaticus eine Ermüdung der Atemmuskulatur und ein ventilatorisches Versagen verursachen. Eine Entlastung der Atempumpe kann durch CPAP, Pressure Support oder kontrollierte Beatmung erfolgen. CPAP reduziert das inspiratorische pressure-timeproduct durch Reduktion der durch den PEEPi bedingten elastischen Atemarbeit. Pressure Support verbessert zusätzlich die alveoläre Ventilation. Beide Beatmungsmodes können auch nicht-invasiv über eine Maske durchgeführt werden. Bei kontrollierter Beatmung muß eine Überblähung durch Wahl niedriger Atemzugvolumina und langer Exspirationszeiten (niedrige Atemfrequenz, I: E — Verhältnis = 1: 3, 1: 4) vermieden werden. Im Weaning von der kontrollierten Beatmung werden Pressure Support und CPAP angewendet.

Summary

An imbalance of pump capacity and load on the respiratory pump due to marked impaired respiratory mechanics may cause respiratory muscle fatigue and ventilatory failure in patients with status asthmaticus. The application of CPAP, pressure support or controlled mechanical ventilation reduces the load on the respiratory pump. CP AP reduces the inspiratory pressure-time product eliminating the elastic work of breathing caused by PEEPi. Additionally pressure support improves alveolar ventilation. Both ventilatory modes can be applied non invasively via a face mask. During controlled mechanical ventilation dynamic hyperinflation has to be avoided by choosing low tidal volumes and long exspiratory times (low breathing frequency, I: E = 1: 3, 1: 4). During weaning from controlled mechanical ventilation pressure support and CPAP are also used.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 29.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 39.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Reference

  1. Rodriguez-Roisin R (1997) Acute severe asthma: Pathophysiology and pathobiology of gas exchange abnomalities. Eur Respir J 10: 1359-1371

    Article  PubMed  CAS  Google Scholar 

  2. Fleury B, Murciano D, Talamo C, Aubier M, Pariente R, Milic Emili J (1985) Work of breathing in patients with chronic obstructive pulmonary disease in acute respiratory failure. Am Rev Respir Dis 132: 822

    Google Scholar 

  3. Knowles GK, Clark TJ (1973) Pulsus paradoxus as a valuable sign indicating severity of asthma. Lancet 2: 1356-1359

    Article  PubMed  CAS  Google Scholar 

  4. Macklem PT (1984) Hyperinflation. Am Rev Respir Dis 129: 1

    PubMed  CAS  Google Scholar 

  5. Decramer M (1989) Effects of hyperinflation on the respiratory muscle. Eur Respir J 2: 299

    PubMed  CAS  Google Scholar 

  6. Roussos C (1990) Respiratory muscle fatigue and ventilatory failure. Chest 97: 89S-96S

    PubMed  CAS  Google Scholar 

  7. Pepe PE, Marini JJ (1982) Occult positive end-exspiratory pressure in mechanically ventilated patients with airflow obstruction. Am Rev Respir Dis 126: 166-170

    PubMed  CAS  Google Scholar 

  8. Rossi A, Polese G, Brandi G, Conti G (1995) Intrinsic positive endexspiratory pressure (PEEPi). Intensive Care Med 21: 522-536

    Article  PubMed  CAS  Google Scholar 

  9. Rossi A, Ganassini A, Polese G, Grassi V (1997) Pulmonary hyperinflation and ventilator-dependent patients. Eur Respir J 10: 1663-1674

    Article  PubMed  CAS  Google Scholar 

  10. Corbridge TC, Hall JB (1995) The assessment and management of adults with status asthmaticus. Am J Respir Crit Care Med 151: 1296-1316

    PubMed  CAS  Google Scholar 

  11. Levy BD, Kitch B, Fanta CH (1998) Medical and ventilatory management of status asthmaticus. Intensive Care Med 24: 105-117

    Article  PubMed  CAS  Google Scholar 

  12. Martin JG, Shore S, Engel LA (1982) Effect of continuous positive airway pressure on respiratory mechanics and pattern of breathing in induced asthma. Am Rev Respir Dis 126: 812-817

    PubMed  CAS  Google Scholar 

  13. Petrof BJ, Legare M, Goldberg P, Milic Emili J, Gottfried SB (1990) Continuous positive airway pressure reduces work of breathing and dyspnea during weaning from mechanical ventilation in severe chronic obstructive pulmonary disease. Am Rev Respir Dis 141: 281-289

    PubMed  CAS  Google Scholar 

  14. Heindl W, Kapfhammer G (1989) Die Messung des intrinsic PEEP bei spontanatmenden COPD-Patienten. Intensivmed 26: 284-289

    Google Scholar 

  15. Kapfhammer G, Heindl W (1992) CPAP reduces intrinsic PEEP component of inspiratory pressure time product. Eur Respir J 5 [Suppl 151: 421s

    Google Scholar 

  16. Brochard L, Harf A, Lorino H, Lemaire F (1989) Inspiratory pressure support prevents diaphragmatic fatigue during weaning from mechanical ventilation. Am Rev Respir Dis 139: 513-521

    Article  PubMed  CAS  Google Scholar 

  17. Appendini L, Patessio A, Zanaboni S, Carone M, Gukov B, Donner CF et al (1994) Physiologic effects of positive end-exspiratory pressure and mask pressure support during exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 149: 1069-1076

    PubMed  CAS  Google Scholar 

  18. Brochard L, Isabey D, Piquet J, Amaro P, Mancebo J, Messadi AA (1990) Reversal of acute exacerbation of chronic obstructive lung disease by inspiratory assistance with a face mask. N Engl J Med 323: 1523-1530

    Article  PubMed  CAS  Google Scholar 

  19. Kramer N, Meyer TJ, Meharg J, Cece RD, Hill NS (1995) Randomized prospective trial of non-invasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med 151: 1799-1806

    PubMed  CAS  Google Scholar 

  20. Brochard L, Mancebo J, Wysocki,M, Lofaso F, Conti G, Rauss A et al (1995) Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 333: 817-822

    Article  PubMed  CAS  Google Scholar 

  21. Bott J, Carrol MB, Convey JH et al (1993) Randomized controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease. Lancet 341: 1555-1557

    Article  PubMed  CAS  Google Scholar 

  22. Meduri GU, Turner RE, Abou-Shala N, Wunderink R, Tolley E (1996) Noninvasive positive pressure ventilation via face mask: first line intervention in patients with acute hypercapnic and hypoxemic respiratory failure. Chest 109: 179-193

    Article  PubMed  CAS  Google Scholar 

  23. Tuxen D, Williams TJ, Scheinkestel CD, Czarny D, Bowes G (1992) Use of a measurement of pulmonary hyperinflation to control the level of hyperventilation of patients with acute severe asthma. Am Rev Respir Dis 146: 1136-1142

    PubMed  CAS  Google Scholar 

  24. Williams T, Tuxen DV. Scheinkestel CD, Czarny D, Bowes G (1992) Risk factors for morbidity in mechanically ventilated patients with acute severe asthma. Am Rev Respir Dis 146: 607-615

    Google Scholar 

  25. Valta P, Corbeil C, Lavoie A, Campodonico R, Koulouris N, Chassé M, Braidy J, Milic-Emili J (1994) Detection of exspiratory flow limitation during mechanical ventilation. Am J Respir Crit Care Med 150: 1311-1317

    PubMed  CAS  Google Scholar 

  26. Marini JJ (1989) Should PEEP be used in airflow obstruction? (Editorial). Am Rev Respir Dis 140: 1-3

    Article  PubMed  CAS  Google Scholar 

  27. Ranieri MV, Giuliani R, Cinnella G et al (1993) Physiologic effects of positive end-exspiratory pressure in patients with chronic obstructive pulmonary disease during acute ventilatory failure and controlled mechanical ventilation. Am Rev Respir Dis 147: 5-13

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pulmologisches Zentrum der Stadt Wien, Österreich

    Werner Heindl

Authors
  1. Werner Heindl
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. 2. Medizinische Abteilung mit Lungenkrankheiten und Tuberkulose, Wilhelminenspital, Wien, Österreich

    Friedrich Kummer

  2. Abteilung für Klinische Pulmologie, Medizinische Universitätsklinik IV, AKH, Wien, Österreich

    Meinhard Kneußl

Rights and permissions

Reprints and permissions

Copyright information

© 2000 Springer-Verlag Wien

About this paper

Cite this paper

Heindl, W. (2000). Beatmungsstrategien beim schweren therapieresistenten Asthma. In: Kummer, F., Kneußl, M. (eds) Das therapieresistente Asthma. Springer, Vienna. https://doi.org/10.1007/978-3-7091-6335-1_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-7091-6335-1_2

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-83401-5

  • Online ISBN: 978-3-7091-6335-1

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation