Airway Management in der Intensivmedizin

Kernaussagen

• Ein gutes Atemwegsmanagement erfordert eine sorgfältige klinische Einschätzung des Patienten, das Bereithalten von Notfallausrüstung sowie eine Abwägung, Planung und Kommunikation des Vorgehens mit allen Beteiligten.

• In einer CICV-Situation sollte man zunächst immer eine Larynxmaske, idealerweise eine ILMA, einlegen.

• Misslingt der erste Intubationsversuch, sollte man beim zweiten einen Führungsstab verwenden. Bei Erfolglosigkeit folgt der Einsatz des Videolaryngoskops, falls dieses nicht bereits beim ersten Versuch eingesetzt wurde. Bei einem erneuten Intubationsversagen kommt dann die ILMA zum Einsatz, bei abermaligem Misslingen steht vor dem invasiven Atemweg (chirurgisch oder perkutan) noch der Einsatz der Fiberoptik.

• Videolaryngoskope sollten zum Bestand des Trolleys „Atemwegssicherung“ auf Intensivstationen gehören.

• Ein kurzes, starres Bronchoskop („Notrohr“) und ein ösophagotrachealer Kombitubus sind „nichtinvasive“ Optionen, falls es nicht gelingt, den Patienten mit einem supraglottischen Atemweg ausreichend zu beatmen.

• Die Extubation und Dekanülierung sind potenziell gefährlich. Daher muss man sie wie eine Intubation sorgfältig planen und durchführen.

• Die individuelle klinische Kompetenz bei der Atemwegssicherung beruht auf der sicheren Beherrschung einer Auswahl sich sinnvoll ergänzender Techniken und Geräte.

• Stationsintern sollte eine Strategie zur Atemwegssicherung- (festgelegt in Algorithmen und Checklisten) definiert und kommuniziert werden.

• Ein regelmäßig wiederholtes Training schwieriger Atemwegssituationen ist dringend zu fordern (idealerweise im Team).

• Eine vorausschauende Planung des nächsten Schritts, frühes Rufen um Hilfe und der Verzicht auf falschen Ehrgeiz sind essenziell, um Atemwegskatastrophen zu vermeiden.

• Literatur

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