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Pneumologie 2022; 76(03): 159-216
DOI: 10.1055/a-1554-2625
Leitlinie

S3-Leitlinie Sauerstoff in der Akuttherapie beim Erwachsenen

German S3 Guideline – Oxygen Therapy in the Acute Care of Adult Patients
Jens Gottlieb
 1   Klinik für Pneumologie, Medizinische Hochschule Hannover
 2   Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH) im Deutschen Zentrum für Lungenforschung (DZL)
,
Philipp Capetian
 3   Klinik für Neurologie, Neurologische Intensivstation, Universitätsklinikum Würzburg
,
Uwe Hamsen
 4   Fachbereich für Unfallchirurgie und Orthopädie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum
,
Uwe Janssens
 5   Innere Medizin und internistische Intensivmedizin, Sankt Antonius Hospital GmbH, Eschweiler
,
Christian Karagiannidis
 6   Abteilung für Pneumologie und Beatmungsmedizin, ARDS/ECMO Zentrum, Lungenklinik Köln-Merheim
,
Stefan Kluge
 7   Klinik für Intensivmedizin, Universitätsklinikum Eppendorf, Hamburg
,
Marco König
 8   Deutscher Berufsverband Rettungsdienst e. V., Lübeck
,
Andreas Markewitz
 9   ehem. Klinik für Herz- und Gefäßchirurgie Bundeswehrzentralkrankenhaus Koblenz
,
Monika Nothacker
10   Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V., Marburg
,
Sabrina Roiter
11   Israelitisches Krankenhaus Hamburg, Intensivstation
,
Susanne Unverzagt
12   Abteilung für Allgemeinmedizin, Universität Leipzig
,
Wolfgang Veit
13   Bundesverband der Organtransplantierten e. V., Marne
,
Thomas Volk
14   Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, Homburg/Saar
,
Christian Witt
15   Seniorprofessor Innere Medizin und Pneumologie, Charité Berlin
,
René Wildenauer
16   Hausarztzentrum Wiesentheid
,
Heinrich Worth
17   Facharztzentrum Fürth
,
Thomas Fühner
18   Krankenhaus Siloah, Klinik für Pneumologie und Beatmungsmedizin, Klinikum Region Hannover
 2   Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH) im Deutschen Zentrum für Lungenforschung (DZL)
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Zusammenfassung

Hintergrund Sauerstoff (O2) ist ein Arzneimittel mit spezifischen biochemischen und physiologischen Eigenschaften, einem definierten Dosis-Wirkungsbereich und mit unerwünschten Wirkungen. Im Jahr 2015 wurden 14 % von über 55 000 Krankenhauspatienten in Großbritannien mit O2 behandelt. Nur 42 % der Patienten hatten dabei eine O2-Verordnung. Gesundheitspersonal ist oft unsicher über die Relevanz einer Hypoxämie, und es besteht ein eingeschränktes Bewusstsein für die Risiken einer Hyperoxämie. In den letzten Jahren wurden zahlreiche randomisierte kontrollierte Studien zu Zielen der Sauerstofftherapie veröffentlicht. Eine nationale Leitlinie ist deswegen dringend erforderlich.

Methoden Im Rahmen des Leitlinienprogramms der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF) wurde unter Beteiligung von 10 Fachgesellschaften eine S3-Leitlinie entwickelt und im Juni 2021 veröffentlicht. Bis zum 1. 2. 2021 wurde eine Literaturrecherche durchgeführt, um 10 Schlüsselfragen zu beantworten. Zur Klassifizierung von Studientypen hinsichtlich ihrer Validität wurde das Oxford Centre for Evidence-Based Medicine (CEBM) System („The Oxford 2011 Levels of Evidence“) verwendet. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) wurde verwendet und zur Bewertung der Evidenzqualität und zur Einstufung von Leitlinienempfehlungen wurde ein formaler Konsensbildungsprozess durchgeführt.

Ergebnisse Die Leitlinie enthält 34 evidenzbasierte Empfehlungen zu Indikation, Verordnung, Überwachung und Abbruch der Sauerstofftherapie in der Akutversorgung. Die Hauptindikation für die O2-Therapie ist Hypoxämie. In der Akutmedizin sollten sowohl Hypoxämie als auch Hyperoxämie vermieden werden. Hyperoxämie scheint mit einer erhöhten Sterblichkeit verbunden zu sein, insbesondere bei Patienten mit Hyperkapnie. Die Leitlinie empfiehlt Zielsauerstoffsättigung für die Akuttherapie mit O2 ohne Differenzierung zwischen Diagnosen. Zielbereiche sind abhängig vom Hyperkapnierisko und Beatmungsstatus. Die Leitlinie bietet einen Überblick über verfügbare Sauerstoffzufuhrsysteme und enthält Empfehlungen für deren Auswahl basierend auf Patientensicherheit und -komfort.

Fazit Dies ist die erste nationale Leitlinie zum Einsatz von Sauerstoff in der Akutmedizin. Sie richtet sich an medizinisches Fachpersonal, das Sauerstoff außerklinisch und stationär anwendet. Sie ist bis zum 30. 06. 2024 gültig.

Abstract

Background Oxygen (O2) is a drug with specific biochemical and physiologic properties, a range of effective doses and may have side effects. In 2015, 14 % of over 55 000 hospital patients in the UK were using oxygen. 42 % of patients received this supplemental oxygen without a valid prescription. Healthcare professionals are frequently uncertain about the relevance of hypoxemia and have low awareness about the risks of hyperoxemia. Numerous randomized controlled trials about targets of oxygen therapy have been published in recent years. A national guideline is urgently needed.

Methods A S3-guideline was developed and published within the Program for National Disease Management Guidelines (AWMF) with participation of 10 medical associations. Literature search was performed until Feb 1st 2021 to answer 10 key questions. The Oxford Centre for Evidence-Based Medicine (CEBM) System (“The Oxford 2011 Levels of Evidence”) was used to classify types of studies in terms of validity. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used and for assessing the quality of evidence and for grading guideline recommendation and a formal consensus-building process was performed.

Results The guideline includes 34 evidence-based recommendations about indications, prescription, monitoring and discontinuation of oxygen therapy in acute care. The main indication for O2 therapy is hypoxemia. In acute care both hypoxemia and hyperoxemia should be avoided. Hyperoxemia also seems to be associated with increased mortality, especially in patients with hypercapnia. The guideline provides recommended target oxygen saturation for acute medicine without differentiating between diagnoses. Target ranges for oxygen saturation are depending on ventilation status risk for hypercapnia. The guideline provides an overview of available oxygen delivery systems and includes recommendations for their selection based on patient safety and comfort.

Conclusion This is the first national guideline on the use of oxygen in acute care. It addresses healthcare professionals using oxygen in acute out-of-hospital and in-hospital settings. The guideline will be valid for 3 years until June 30, 2024.



Publication History

Article published online:
02 September 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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