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Pneumologie 2015; 69(10): 595-607
DOI: 10.1055/s-0034-1392809
Guideline
© Georg Thieme Verlag KG Stuttgart · New York

S2k-Guideline “Prolonged Weaning”[*]

Published by German Respiratory Society (Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V., DGP)S2k-Leitlinie „Prolongiertes Weaning“Herausgegeben von der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin (DGP)
B. Schönhofer
1   Prof. Dr. Bernd Schönhofer, Pneumologie, Internistische Intensivmedizin und Schlafmedizin KRH Klinikum Siloah-Oststadt-Heidehaus, Stadionbrücke 4, 30459 Hannover; E-Mail: Bernd.Schoenhofer@t-online.de
,
J. Geiseler
2   Dr. Jens Geiseler, Asklepios Fachkliniken München-Gauting, Klinik für Intensiv-, Schlaf- und Beatmungsmedizin, Robert-Koch-Allee 2, 82131 Gauting; E-Mail: j.geiseler@asklepios.com
,
D. Dellweg
3   PD Dr. Dominic Dellweg, Fachkrankenhaus Kloster Grafschaft, Annostraße 1, 57392 Schmallenberg; E-Mail: d.dellweg@fkkg.de
,
O. Moerer
4   Prof. Dr. Onnen Moerer, Universitätsmedizin Göttingen, Klinik für Anästhesiologie, Zentrum Anästhesiologie, Rettungs- und Intensivmedizin, Robert-Koch Straße 40, 37075 Göttingen; E-Mail: omoerer@gwdg.de
,
T. Barchfeld
5   Dr. Thomas Barchfeld, Klinikum Westfalen GmbH, Knappschaftskrankenhaus Dortmund, Klinik für Pneumologie, Intensivmedizin und Schlafmedizin, Am Knappschaftskrankenhaus 1, 44309 Dortmund; E-Mail: thomas.barchfeld@klinikum-westfalen.de
,
H. Fuchs
6   Dr. Hans Fuchs, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Mathildenstraße 1, 79106 Freiburg; E-Mail: hans.fuchs@uniklinik-freiburg.de
,
O. Karg
7   Dr. Ortrud Karg, Asklepios Fachkliniken München-Gauting, Leitung Medizinische Krankenhausorganisation, Robert-Koch-Allee 2, 82131 Gauting; E-Mail: o.karg@t-online.de
,
S. Rosseau
8   Dr. Simone Rosseau, Charité Universitätsmedizin Berlin, Charité – Campus Mitte, Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charitéplatz 1, 10117 Berlin; E-Mail: simone.rosseau@charite.de
,
H. Sitter
9   PD Dr. Helmut Sitter, Philips-Universität Marburg, Institut für Chirurgische Forschung, Baldingerstraße, 35033 Marburg; E-Mail: sitter@med.uni-marburg.de
,
S. Weber-Carstens
10   PD Dr. Steffen Weber-Carstens, Charité Universitätsmedizin Berlin, Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin; E-Mail: Steffen.Weber-Carstens@charite.de
,
M. Westhoff
11   Dr. Michael Westhoff, Lungenklinik Hemer, Klinik Pneumologie I, Theo-Funccius-Straße 1, 58675 Hemer; E-Mail: michaelwesthoff.mail@t-online.de
,
W. Windisch
12   Prof. Dr. Wolfram Windisch, Kliniken der Stadt Köln gGmbH, Abteilung Pneumologie, Ostmerheimer Straße 200, 51109 Köln; E-Mail: WindischW@kliniken-koeln.de
› Author Affiliations
Further Information

Publication History

Publication Date:
07 October 2015 (online)

Also available at
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Abstract

All mechanically ventilated patients must be weaned from the ventilator at some stage. According to an International Consensus Conference the criteria for “prolonged weaning” are fulfilled if patients fail at least 3 weaning attempts (i. e. spontaneous breathing trial, SBT) or require more than 7 days of weaning after the first SBT. This occurs in about 15 – 20 % of patients.

Because of the growing number of patients requiring prolonged weaning a German guideline on prolonged weaning has been developed. It is an initiative of the German Respiratory Society (Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V., DGP) in cooperation with other societies (see acknowledgement) engaged in the field chaired by the Association of Scientific and Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF).

This guideline deals with the definition, epidemiology, weaning categories, underlying pathophysiology, therapeutic strategies, the weaning unit, transition to out-of-hospital ventilation and therapeutic recommendations for end of life care.

This short version summarises recommendations on prolonged weaning from the German guideline.

Zusammenfassung

Die Entwöhnung von der maschinellen Beatmung (Weaning) umfasst einen wesentlichen Teil der gesamten Beatmungszeit. Dabei kommt es bei ca. 15 – 20 % der Patienten zu einem prolongierten Weaning, das nach internationaler Vereinbarung dann angenommen wird, wenn das Weaning erst nach drei erfolglosen Spontanatmungsversuchen (Spontaneous Breathing Trial = SBT) oder nach über 7 Tagen Beatmung nach dem ersten erfolglosen SBT gelingt. Auf Initiative der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin e.V. (DGP) gemeinsam mit anderen wissenschaftlichen Gesellschaften und unter der Moderation der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) e.V. wurde der aktuelle Wissensstand zum Thema „Prolongiertes Weaning“ in einer S2k-Leitlinie zusammengefasst. In dieser Leitlinie werden Definitionen, Epidemiologie und Weaningkategorien, die zugrunde liegende Pathophysiologie, die verfügbaren Therapiestrategien, die Weaningeinheit, die Überleitung in eine außerklinische Beatmung und schließlich Empfehlungen zu Therapieentscheidungen am Ende des Lebens bei prolon- giertem bzw. erfolglosem Weaning abgehandelt. Die Besonderheiten bei pädiatrischen Patienten werden innerhalb der einzelnen Kapitel jeweils gesondert behandelt. In der vorliegenden Kurzfassung werden die wesentlichen Aspekte und Empfehlungen dieser Leitlinie zum prolongierten Weaning vorgestellt.

* Authors’ contributions: The authors listed in this publication represent the leaders of the different subject areas during the guideline development. They all participated in the consensus conferences of this project and had responsibility for the preparation of the original document. BS, OM, JG and DD structured, prepared and translated the English written document for this publication.


 

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