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Maskenbeatmung als Rückzugsstrategie zur endotrachealen Intubation

Mask ventilation as an exit strategy of endotracheal intubation

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Zusammenfassung

Ziele der Beatmung eines ungeschützten Atemweges sind Oxygenierung und Kohlendioxidelimination des Patienten. Dies kann mit Techniken, wie der Mund-zu-Mund- oder besser der Maskenbeatmung, erreicht werden. Zur Atemwegssicherung ist die Intubation der Goldstandard; allerdings hängt hier der Erfolg, v. a. im Notfall, von der initialen Ausbildung und einem kontinuierlichen klinischen Training sowie der Frequenz der Durchführung bei der täglichen Arbeit des Retters ab. „Patienten sterben nicht an der fehlenden Intubation; sie sterben, weil die Intubationsversuche nicht unterlassen werden oder an nichtdiagnostizierter ösophagealer Intubation“ (Scott 1986). Daher sollte eine suffiziente Maskenbeatmung für den im Atemwegsmanagement unerfahrenen Retter absolute Priorität haben. Bei der Ventilation eines ungeschützten Atemweges kann es zu einer Magenbeatmung mit daraus folgenden schwer wiegenden Komplikationen kommen. Vorbeugend kann mit niedrigem Inspirationsdruck und -fluss und dadurch mit geringeren Tidalvolumina bei einer hohen inspiratorischen Sauerstoffkonzentration beatmet werden. Dies könnte eine Strategie für mehr Patientensicherheit darstellen.

Abstract

The goal of ventilation in an unprotected airway is to optimize oxygenation and carbon dioxide elimination of the patient. This can be achieved with techniques such as mouth-to-mouth ventilation, but preferably with bag-valve-mask ventilation. Securing the airway with an endotracheal tube is the gold standard, but excellent success in emergency airway management depends on initial training, retraining, and actual frequency of a given procedure in the routine. “Patients do not die from failure to intubate; they die from failure to stop trying to intubate or from undiagnosed oesophageal intubation” (Scott 1986). Therefore, adequate face mask ventilation has absolute priority in airway management by an unexperienced rescuer. During ventilation of an unprotected airway, stomach inflation and subsequent severe complications may result. Careful ventilation can be performed with low inspiratory pressure and flow, and subsequently with a low tidal volume at a high inspiratory fraction of oxygen. This could be a strategy to achieve more patient safety.

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Authors and Affiliations

  1. Univ.-Klinik für Anaesthesie und Allgemeine Intensivmedizin, Medizinische Universität, Innsbruck, Österreich

    A. von Goedecke, C. Keller, W. G. Voelckel, M. Dünser, P. Paal, C. Torgersen & V. Wenzel

  2. Univ.-Klinik für Anaesthesie und Allgemeine Intensivmedizin, Medizinische Universität, Anichstrasse 35, 6020, Innsbruck, Österreich

    A. von Goedecke

Authors
  1. A. von Goedecke
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  2. C. Keller
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  3. W. G. Voelckel
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  4. M. Dünser
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  5. P. Paal
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  6. C. Torgersen
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  7. V. Wenzel
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Correspondence to A. von Goedecke.

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Diese Arbeit wurde unterstützt von der Österreichischen Nationalbank, Projekt 9513 und 11448, Wien, Österreich.

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von Goedecke, A., Keller, C., Voelckel, W.G. et al. Maskenbeatmung als Rückzugsstrategie zur endotrachealen Intubation. Anaesthesist 55, 70–79 (2006). https://doi.org/10.1007/s00101-005-0927-x

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  • DOI: https://doi.org/10.1007/s00101-005-0927-x

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