Nichtinvasive Atemunterstützung bei Frühgeborenen – verbessertes Outcome und geringere Lungenschädigung?

In den letzten Jahren haben nichtinvasive Beatmungsmethoden in der Neonatologie zunehmend an Bedeutung gewonnen und lösen das früher übliche Vorgehen zunehmend ab, kleine Frühgeborene primär nach Geburt zu intubieren und invasiv zu beatmen. Dieser Beitrag gibt einen Überblick über häufig genutzte Verfahren mit ihren Anwendungsgebieten sowie Vor- und Nachteilen.

Kernaussagen

• Eine längere Anwendung von nCPAP scheint das Lungenwachstum zu stimulieren.

• NIPPV verringert im Vergleich zu nCPAP die Atemarbeit und das Risiko eines Pneumothorax sowie das Risiko eines respiratorischen Versagens nach Extubation.

• NIPPV reduziert im Vergleich zu nCPAP nicht das Risiko einer BPD oder des Versterbens.

• Asynchronie von Patient und Beatmungsgerät ist bei Frühgeborenen häufig. Eine Synchronisation der NIPPV führt zu verringerten Entsättigungen und/oder Bradykardien, hat aber keine langfristige Verbesserung des klinischen Outcomes zur Folge.

• Eine nasale High-Flow-Therapie ist nach Extubation dem CPAP vergleichbar, als primäre Atemunterstützung nach Geburt aber nicht zu empfehlen.

• Die nHFOV kann insbesondere bei Hyperkapnie individuell bei Frühgeborenen eingesetzt werden, die auf konventionelle NIPPV ungenügend ansprechen.

• NIV-NAVA scheint eine erfolgversprechende neue Therapieform zu sein, die gegenwärtig erprobt wird.

Schlüsselwörter

nichtinvasive Beatmung - Frühgeborene - CPAP - NIPPV - High-Flow-Therapie

Publikationsverlauf

Artikel online veröffentlicht:
03. September 2021

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