Nicht-invasive Beatmung als Therapie der akuten respiratorischen Insuffizienz^[*]

Zusammenfassung

Die nicht-invasive Beatmung (NIV) ist in der klinischen Medizin weit verbreitet und hat mittlerweile einen hohen Stellenwert im klinischen Alltag erlangt. Der Einsatz der NIV reduziert die Intensiv- und Krankenhausaufenthaltsdauer sowie die Mortalität von Patienten mit akutem hyperkapnischen Atemversagen. Patienten mit akuter respiratorischer Insuffizienz im Rahmen eines Lungenödems sollten neben den notwendigen kardiologischen Interventionen mit CPAP oder NIV behandelt werden. Bei anderen Formen des akuten hypoxämischen Atemversagens wird empfohlen, den Einsatz der NIV auf lediglich mildes ARDS zu begrenzen, da eine NIV bei schweren Formen mit höheren Raten von Therapieversagen und Mortalität assoziiert ist. Im Weaning von invasiver Beatmung reduziert die NIV die Reintubationsraten im Wesentlichen bei hyperkapnischen Patienten. Eine verzögerte Intubation bei Auftreten eines NIV-Versagens führt zu einem Anstieg der Mortalität und sollte deshalb vermieden werden. Bei entsprechendem Monitoring auf der Intensivstation kann die NIV auch bei pädiatrischen Patienten mit akuter respiratorischer Insuffizienz erfolgreich eingesetzt werden. Weiterhin kann im Rahmen der Palliativmedizin die NIV hilfreich bei der Reduktion von Dyspnoe und Verbesserung von Lebensqualität sein. Ziel des Updates dieser Leitlinie ist es, unter Berücksichtigung der zunehmenden aktuellen wissenschaftlichen Evidenz, sowohl die Vorteile als auch die Limitationen der NIV in der Behandlung der akuten respiratorischen Insuffizienz in der täglichen klinischen Praxis und bei verschiedenen Indikationen aufzuzeigen.

Abstract

The non-invasive ventilation (NIV) is widespread in the clinical medicine and has attained meanwhile a high value in the clinical daily routine. The application of NIV reduces the length of ICU stay and hospitalization as well as mortality of patients with hypercapnic acute respiratory failure. Patients with acute respiratory failure in context of a cardiopulmonary edema should be treated in addition to necessary cardiological interventions with continuous positive airway pressure (CPAP) or NIV. In case of other forms of acute hypoxaemic respiratory failure it is recommended the application of NIV to be limited to mild forms of ARDS as the application of NIV in severe forms of ARDS is associated with higher rates of treatment failure and mortality. In weaning process from invasive ventilation the NIV reduces the risk of reintubation essentially in hypercapnic patients. A delayed intubation of patients with NIV failure leads to an increase of mortality and should therefore be avoided. With appropriate monitoring in intensive care NIV can also be successfully applied in pediatric patients with acute respiratory insufficiency. Furthermore NIV can be useful within palliative care for reduction of dyspnea and improving quality of life. The aim of the guideline update is, taking into account the growing scientific evidence, to outline the advantages as well as the limitations of NIV in the treatment of acute respiratory failure in daily clinical practice and in different indications.

Unter Mitwirkung der folgenden Wissenschaftlichen Fachgesellschaften und Institutionen:
Deutsche Interdisziplinäre Gesellschaft für Außerklinische Beatmung (DIGAB) e. V.
Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) e. V.
Deutsche Gesellschaft für Chirurgie (DGCh) e. V.
Deutsche Gesellschaft für Fachkrankenpflege und Funktionsdienste (DGF) e. V.
Deutsche Gesellschaft für Geriatrie (DGG) e. V.
Deutsche Gesellschaft für Internistische Intensivmedizin (DGIIN) e. V.
Deutsche Gesellschaft für Kardiologie (DGK) e. V.
Gesellschaft für Neonatologie und pädiatrische Intensivmedizin (GNPI) e. V.
Deutsche Gesellschaft für Neurologie (DGN) e. V.
Deutsche Gesellschaft für NeuroIntensivmedizin (DGNI) e. V. und Deutsche Gesellschaft für Palliativmedizin (DGP) e. V.

Verabschiedet von den Vorständen der beteiligten Fachgesellschaften 10. 07. 2015.

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