S2k-Leitlinie: Nichtinvasive und invasive Beatmung als Therapie der chronischen respiratorischen Insuffizienz – Revision 2017^[*]

Zusammenfassung

Die außerklinische Beatmung über einen invasiven oder nichtinvasiven Beatmungszugang ist mittlerweile etablierter Standard. Entsprechend wurde bereits im Jahr 2010 unter der Federführung der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin e. V. (DGP) die Leitlinie „Nichtinvasive und invasive Beatmung als Therapie der chronischen respiratorischen Insuffizienz“ publiziert. Die stetige Weiterentwicklung der technischen Methoden, neue wissenschaftliche Erkenntnisse sowie neue versorgungsrelevante Entwicklungen machen jedoch eine umfangreiche Revision der Leitlinie notwendig.

Entsprechend wurde nun die revidierte Fassung der Leitlinie publiziert. Dabei finden sich in Bezug auf die aktuelle Literatur sowie auf die Versorgungslandschaft in Deutschland überarbeitete Empfehlungen zu den bereits in der Erstversion der Leitlinie aufgenommenen Themenbereichen der technischen Aspekte, der Organisationsstrukturen in Deutschland, der Qualifikationskriterien für die Versorgung außerklinisch beatmeter Patienten, für die einzelnen Krankheitsentitäten inklusive der Besonderheiten in der Pädiatrie sowie der ethischen Aspekte und der Palliativmedizin. Neu hinzugenommen sind zusätzlich die Themen der außerklinischen Beatmung nach erfolglosem prolongierten Weaning sowie die außerklinische Beatmung bei Querschnittlähmung.

Neu ist auch die Zusammensetzung der beteiligten Fachgesellschaften, Fachverbände und Vereinigungen. Dabei werden die einzelnen Krankheitsbilder und Organsysteme übergreifend auch über die Deutsche Interdisziplinäre Gesellschaft für Außerklinische Beatmung e. V. (DIGAB) vertreten, während zusätzlich die Einbindung von Verbänden wichtig war, die direkt mit der Versorgung beatmeter Patienten im außerklinischen Setting konfrontiert sind. Zusätzlich wurde die Einbindung der Kostenträgerseite und der Patientenverbände für wichtig erachtet.

Diese Leitlinie hat eine Gültigkeit von drei Jahren, beginnend mit dem Datum der Veröffentlichung auf der Homepage der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF) Anfang Juli 2017. Ziel ist eine weitere zeitgerechte Überarbeitung der Leitlinie nach Fristablauf.

Abstract

Today, invasive and non-invasive home mechanical ventilation have become a well-established treatment option. Consequently, in 2010 the German Society of Pneumology and Mechanical Ventilation (DGP) has leadingly published the guidelines on “Non-Invasive and Invasive Mechanical Ventilation for Treatment of Chronic Respiratory Failure”. However, continuing technical evolutions, new scientific insights, and health care developments require an extensive revision of the guidelines.

For this reason, the updated guidelines are now published. Thereby, the existing chapters, namely technical issues, organizational structures in Germany, qualification criteria, disease specific recommendations including special features in pediatrics as well as ethical aspects and palliative care, have been updated according to the current literature and the health care developments in Germany. New chapters added to the guidelines include the topics of home mechanical ventilation in paraplegic patients and in those with failure of prolonged weaning.

In the current guidelines different societies as well as professional and expert associations have been involved when compared to the 2010 guidelines. Importantly, disease-specific aspects are now covered by the German Interdisciplinary Society of Home Mechanical Ventilation (DIGAB). In addition, societies and associations directly involved in the care of patients receiving home mechanical ventilation have been included in the current process. Importantly, associations responsible for decisions on costs in the health care system and patient organizations have now been involved.

The currently updated guidelines are valid for the next three years, following their first online publication on the home page of the Association of the Scientific Medical Societies in German (AWMF) in the beginning of July 2017. A subsequent revision of the guidelines remains the aim for the future.

^* Erstmalig publiziert auf der Homepage der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) (http://www.awmf.org/leitlinien/detail/ll/020-008.html) am 07.07.2017.

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