Welcher Beatmungszugang für welchen Patienten auf der Intensivstation?

Zusammenfassung

Dieser Artikel gibt einen Überblick über die derzeit auf der Intensivstation eingesetzten Beatmungszugänge. Bei der nichtinvasiven Beatmung liegt der Beatmungszugang definitionsgemäß außerhalb des Körpers, wodurch in der Regel keine Analgosedierung vonnöten ist. Hierdurch ist eine gewisse Kooperation vonseiten des Patienten nötig, welches eine sorgfältige Auswahl des Beatmungszuganges voraussetzt. Die Maskenintoleranz stellt das häufigste Problem für das Versagen der nichtinvasiven Beatmung dar. Der am häufigsten verwendete Beatmungszugang bei der nichtinvasiven Beatmung auf der Intensivstation ist die Nasen-Mundmaske. Diese erlaubt dem Patienten eine, bei der akuten respiratorischen Insuffizienz oft notwendige, Mundatmung. Gute Alternativen sind die Vollgesichtsmaske und der Beatmungshelm. Nasenmasken oder Mundstücke werden auf der Intensivstation hingegen nur selten eingesetzt. Die Koniotomie und supraglottische Atemwegshilfen kommen als Notfallmaßnahme beim schwierigen Atemweg auf der Intensivstation zum Einsatz. Der Goldstandard zur Sicherung der Atemwege ist jedoch nach wie vor die endotracheale Intubation, welche mit einer Reihe von potentiellen Komplikationen assoziiert ist. Die Tracheotomie ist der Standardzugang, wenn eine Langzeitbeatmung beim Intensivpatienten absehbar wird.

Abstract

This review presents the potential indications for different airway devices in the intensive care unit (ICU). Since the interface during noninvasive ventilation is located outside the body, sedation is not regularly needed. Therefore, selection of a fitting mask is essential to avoid mask intolerance which is one of the biggest problems during noninvasive ventilation. Full-face masks are the interfaces mostly used for noninvasive ventilation to treat acute respiratory failure; here, mouth breathing is possible which is often necessary during acute respiratory failure. Good alternatives are total face masks and the helmet, whereas nasal masks and mouthpieces are not regularly used on the ICU. Extraglottic airway devices and coniotomy are used for the management of difficult airway situations on the ICU. Endotracheal intubation remains the gold standard procedure for airway management. However, this procedure is associated with a number of complications. Tracheostomy is the airway access of choice when long-term mechanical ventilation is necessary.

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