Weaning in der Situation einer Pandemie – Ein Positionspapier

Zusammenfassung

Die logistischen und infektiologischen Besonderheiten und Erfordernisse in der Pandemie stellen die intensivmedizinischen Behandlungsteams vor außerordentliche Herausforderungen, die eine erfolgreiche Liberation von Patienten im prolongierten Weaning erschweren können. Gerade in der Pandemie gilt es daher, alle Potenziale zur Beatmungsentwöhnung und Dekanülierung von Patienten im prolongierten Weaning oder in der Langzeitbeatmung auszuschöpfen.

Weaning-Zentren stellen Einheiten der intensivmedizinischen Betreuung mit besonderer Spezialisierung auf prolongiertes Weaning dar und sind integraler Bestandteil eines kontinuierlichen Versorgungskonzeptes dieser Patienten. Ein systematisches Weaning-Konzept in der Pandemie setzt strukturelle, personelle, apparative, infektiologische und hygienische Aspekte voraus.

Im Mittelpunkt dieses Positionspapiers stehen als Ergänzung zur S2k-Leitlinie „Prolongiertes Weaning“ eine neue Klassifikation im prolongierten Weaning und zukünftig erforderliche Organisationsstrukturen für die Pandemie-Situation.

Patienten der Kategorie A mit hohem Weaning-Potenzial bedürfen der strukturierten Respiratorentwöhnung in spezialisierten Weaning-Einheiten, um so die größtmögliche Chance auf erfolgreiches Weaning zu realisieren. Patienten der Kategorie B mit geringem oder aktuell nicht vorhandenem Weaning-Potenzial sollten verzögert nach einer Zwischenphase der weiteren Stabilsierung in einer außerklinischen Beatmungseinrichtung einen Weaning-Versuch erhalten. Patienten der Kategorie C ohne Weaning-Potenzial benötigen eine dauerhafte außerklinische Versorgung, alternativ eine palliativmedizinisch begleitete Beendigung der Beatmung. Die sich aus den 3 Kategorien ergebenden Aufgaben für die Weaning-Zentren werden im Positionspapier vertieft.

Schließlich werden unter perspektivischer Betrachtung im Positionspapier folgende zukünftig denkbare Netzwerke und Register benannt: 1. lokal organisierte regionale Netzwerke von zertifizierten Weaning-Zentren, 2. ein zentrales, bundesweites Register der Weaning-Kapazitäten entsprechend dem DIVI-Register und 3. eine Registrierung der Patienten im schwierigen oder prolongierten Weaning.

Abstract

The logistical and infectious peculiarities and requirements challenge the intensive care treatment teams aiming at a successful liberation of patients from long-term mechanical ventilation.

Especially in the pandemic, it is therefore important to use all potentials for weaning and decannulation, respectively, in patients with prolonged weaning.

Weaning centers represent units of intensive medical care with a particular specialization in prolonged weaning. They are an integral part of a continuous care concept for these patients.

A systematic weaning concept in the pandemic includes structural, personnel, equipment, infectiological and hygienic issues.

In addition to the S2k guideline “Prolonged weaning” this position paper hightlights a new classification in prolonged weaning and organizational structures required in the future for the challenging pandemic situation. Category A patients with high weaning potential require a structured respiratory weaning in specialized weaning units, so as to get the greatest possible chance to realize successful weaning. Patients in category B with low or currently nonexistent weaning potential should receive a weaning attempt after an intermediate phase of further stabilization in an out-of-hospital ventilator unit. Category C patients with no weaning potential require a permanent out-of-hospital care, alternatively finishing mechanical ventilation with palliative support.

Finally, under perspective in the position paper the following conceivable networks and registers in the future are presented: 1. locally organized regional networks of certified weaning centers, 2. a central, nationwide register of weaning capacities accordingly the already existing DIVI register and 3. registration of patients in difficult or prolonged weaning.

Publication History

Article published online:
22 December 2020

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