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Pneumologie 2001; 55(1): 21-30
DOI: 10.1055/s-2001-10406
REPORT
Georg Thieme Verlag Stuttgart · New York

Nichtinvasive Positivdruck-beatmung bei akut respiratorischer Insuffizienz - Ein Report der internationalen Konsensus-konferenz der Intensivmedizin, Paris, 13. - 14. 4. 2000

B. Schönhofer
  • Krankenhaus Kloster Grafschaft, Zentrum für Pneumologie, Beatmungs- und Schlafmedizin, 57392 Schmallenberg-Grafschaft
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Publication History

Publication Date:
31 December 2001 (online)

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Organisatorisches zur International Consensus Conference in Intensive Care Medicine

Im Sinne der Standortbestimmung zur Bedeutung der nichtinvasiven Positivdruckbeatmung (NIV) bei akut respiratorischer Insuffizienz (ARI) fand am 13. und 14. April 2000 in Paris eine internationale Konsensuskonferenz statt. Organisiert wurde diese Veranstaltung im Sinne des „Joint meeting” von Vertretern der American Thoracic Society (ATS), der European Respiratory Society (ERS), der European Society of Intensive Care Medicine (ESICM) und der Société de Réanimation de Loung Française (SRLF). Die der Konferenz zugrunde liegende Strategie ging auf Konzepte des National Institutes of Health [1] zurück und wurde im Weiteren den Verhältnissen der Intensivmedizin angepasst [2]. Hierbei wurden bereits vor der Konferenz die zentralen Fragen zum Stellenwert der NIV bei ARI vorformuliert. In einem weiteren Schritt folgte eine Literaturrecherche zu diesem Thema. Diese Literatur wurde einer Jury (bestehend aus international bekannten Wissenschaftlern, die keine ausgewiesene Experten auf dem Feld der NIV waren) zur Verfügung gestellt. Mitglieder der Jury waren: T. Evans (UK), F. Lemaire (Frankreich), J. Mancebo (Spanien), G. Ramsay (Niederlande), C. Richard (Frankreich), C. Sassoon (USA) und A. S. Slutsky (Kanada).

Während der Konsensuskonferenz präsentierten international renommierte Experten auf dem Gebiet der NIV bei ARI in Gegenwart der Jury und eines öffentlichen Auditoriums die Vorträge zu verschiedenen Schwerpunktthemen. Jedem Vortrag folgte eine ausführliche Diskussion zwischen Jury und Experten. Während einer Klausurtagung im unmittelbaren Anschluss an die Konsensuskonferenz wurden dann die wesentlichen Erkenntnisse unter besonderer Berücksichtigung der vorhandenen Evidenz und offen bleibender Fragen von der Jury zusammengefasst. Es ist vorgesehen, dass die wesentlichen Ergebnisse der Konferenz in Kürze in den Organen der beteiligten Gesellschaften veröffentlicht werden.

Literatur

  • 1 NIH. Guidelines for the selection and management of consensus development conferences. In: 1995: Office of medical application of research 1995
    Search in Google Scholar
  • 2 Carlet J, Artigas A, Bihari D. et al . The first European consensus conference in intensive care medicine: introductory remarks.  Intensive Care Med. 1992;  18 180-181
    CrossrefPubMedSearch in Google Scholar
  • 3 Simonds A K, Elliott M W. Outcome of domicilliary nasal intermittent positive pressure ventilation in restrictive and obstructive disorders.  Thorax. 1995;  50 604-609
    CrossrefPubMedSearch in Google Scholar
  • 4 Plant P K, Owen J L, Elliott M W. One year period prevalence study of respiratory acidosis in acute exacerbations of COPD: implications for the provision of non-invasive ventilation and oxygen administration.  Thorax. 2000;  55 (7) 550-554
    CrossrefPubMedSearch in Google Scholar
  • 5 Richard J C, Carlucci A, Wysocki M. et al . French multicenter survey: noninvasive versus conventional mechanical ventilation.  Am J Respir Crit Care Med. 1999;  159 A367
    PubMedSearch in Google Scholar
  • 6 Doherty M J, Greenstone M A. Survey of non-invasive ventilation (NIPPV) in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) in the UK.  Thorax. 1998;  53 863-867
    PubMedSearch in Google Scholar
  • 7 Girault C, Richard J C, Chevron V. et al . Comparative physiologic effects of noninvasive assist-control and pressure support ventilation in acute hypercapnic respiratory failure.  Chest. 1997;  111 (6) 1639-1648
    CrossrefPubMedSearch in Google Scholar
  • 8 Appendini L, Patessio A, Zanaboni S. et al . Physiologic effects of positive end-expiratory pressure and mask pressure support during exacerbations of chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 1994;  149 1069-1076
    CrossrefPubMedSearch in Google Scholar
  • 9 Brochard L, Mancebo J, Wysocki M. et al . Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease.  N Engl J Med. 1995;  333 (13) 817-822
    CrossrefPubMedSearch in Google Scholar
  • 10 Girault C, Chevron V, Richard J C. et al . Physiological effects and optimisation of nasal assist-control ventilation for patients with chronic obstructive pulmonary disease in respiratory failure.  Thorax. 1997;  52 (8) 690-696
    PubMedSearch in Google Scholar
  • 11 Vitacca M, Clini E, Pagani M, Bianchi L, Rossi A, Ambrosino N. Physiologic effects of early administered mask proportional assist ventilation in patients with chronic obstructive pulmonary disease and acute respiratory failure.  Crit Care Med. 2000;  28 (6) 1791-1797
    CrossrefPubMedSearch in Google Scholar
  • 12 Barbé F, Togores B, Rubi M, Pons S, Maimo A, Agusti A G. Noninvasive ventilatory support does not facilitate recovery from acute respiratory failure in chronic obstructive pulmonary disease.  Eur Respir J. 1996;  9 (6) 1240-1245
    CrossrefPubMedSearch in Google Scholar
  • 13 Bott J, Baudouin S V, Moxham J. Nasal intermittent positive pressure ventilation in the treatment of respiratory failure in obstructive sleep apnoea.  Thorax. 1991;  46 (6) 457-458
    PubMedSearch in Google Scholar
  • 14 Kramer N, Meyer T J, Meharg J, Cece R D, Hills N S. Randomized, prospective trial of noninvasive positive pressure ventilation in acute respiratory failure.  Am J Respir Crit Care Med. 1995;  151 (6) 1799-1806
    CrossrefPubMedSearch in Google Scholar
  • 15 Celikel T, Sungur M, Ceyhan B, Karakurt S. Comparison of noninvasive positive pressure ventilation with standard medical therapy in hypercapnic acute respiratory failure.  Chest. 1998;  114 (6) 1636-1642
    CrossrefPubMedSearch in Google Scholar
  • 16 Brochard L, Isabey D, Piquet J. et al . Reversal of acute exacerbations of chronic obstructive lung disease by inspiratory assistance with a face mask.  N Engl J Med. 1990;  323 (22) 1523-1530
    CrossrefPubMedSearch in Google Scholar
  • 17 Antonelli M, Conti G, Rocco M. et al . A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure.  N Engl J Med. 1998;  339 (7) 429-435
    CrossrefPubMedSearch in Google Scholar
  • 18 Patrick W, Webster K, Ludwig L, Roberts D, Wiebe P, Younes M. Noninvasive positive-pressure ventilation in acute respiratory distress without prior chronic respiratory failure.  Am J Respir Crit Care Med. 1996;  153 (3) 1005-1011
    PubMedSearch in Google Scholar
  • 19 Bersten A D, Holt A W, Vedig A E, Skowronski G A, Baggoley C J. Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask.  N Engl J Med. 1991;  325 (26) 1825-1830
    PubMedSearch in Google Scholar
  • 20 Lin M, Yang Y F, Chiang H T, Chang M S, Chiang B N, Cheitlin M D. Reappraisal of continuous positive airway pressure therapy in acute cardiogenic pulmonary edema. Short-term results and long-term follow-up.  Chest. 1995;  107 (5) 1379-1386
    CrossrefPubMedSearch in Google Scholar
  • 21 Mehta S, Jay G D, Woolard R H. et al . Randomized, prospective trial of bilevel versus continuous positive airway pressure in acute pulmonary edema.  Crit Care Med. 1997;  25 (4) 620-628
    CrossrefPubMedSearch in Google Scholar
  • 22 Vaisanen I T, Rasanen J. Continuous positive airway pressure and supplemental oxygen in the treatment of cardiogenic pulmonary edema.  Chest. 1987;  93 (3) 481-485
    PubMedSearch in Google Scholar
  • 23 Jounieaux V, Dury A, Delguste P, Rodenstein D. Effects of nasal positive pressure hyperventilation on the glottis in normal awake subjects.  J Appl Physiol. 1995;  79 176-185
    PubMedSearch in Google Scholar
  • 24 Jounieaux V, Parreira V F, Delguste P, Aubert G, Rodenstein D O. Nasal mask pressure waveform and inspiratory muscle rest during nasal assisted ventilation.  Am J Respir Crit Care Med. 1997;  155 (6) 2096-2101
    PubMedSearch in Google Scholar
  • 25 Keenan S P, Kernerman P D, Cook D J, Martin C M, McCormack D, Sibbald W J. Effect of noninvasive positive pressure ventilation on mortality in patients admitted with acute respiratory failure: a meta-analysis.  Crit Care Med. 1997;  25 (10) 1685-1692
    PubMedSearch in Google Scholar
  • 26 Nava S, Ambrosino N, Clini E. et al . Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease. A randomized, controlled trial.  Ann Intern Med. 1998;  128 (9) 721-728
    CrossrefPubMedSearch in Google Scholar
  • 27 Bunburaphong T, Imanaka H, Nishimura M, Hess D, Kacmarek R M. Performance characteristics of bilevel pressure ventilators: a lung model study.  Chest. 1997;  111 (4) 1050-1060
    PubMedSearch in Google Scholar
  • 28 Aslanian P, El Atrous S, Isabey D. et al . Effects of flow triggering on breathing effort during partial ventilatory support.  Am J Respir Crit Care Med. 1998;  157 (1) 135-143
    PubMedSearch in Google Scholar
  • 29 Bonmarchand G, Chevron V, Menard J F. et al . Effects of pressure ramp slope values on the work of breathing during pressure support ventilation in restrictive patients [published erratum appears in Crit Care Med 1999 Jul; 27 (7): 1404].  Crit Care Med. 1999;  27 (4) 715-722
    PubMedSearch in Google Scholar
  • 30 Lofaso F, Aslanian P, Richard J C. et al . Expiratory valves used for home devices: experimental and clinical comparison.  Eur Respir J. 1998;  11 (6) 1382-1388
    CrossrefPubMedSearch in Google Scholar
  • 31 Ferguson G T, Gilmartin M. CO2 rebreathing during BiPAP ventilatory assistance.  Am J Respir Crit Care Med. 1995;  151 1126-1135
    PubMedSearch in Google Scholar
  • 32 Younes M. Proportional assist ventilation, a new approach to ventilatory support. Theory.  Am Rev Respir Dis. 1992;  145 (1) 114-120
    PubMedSearch in Google Scholar
  • 33 Ranieri V M, Grasso S, Mascia L. et al . Effects of proportional assist ventilation on inspiratory muscle effort in patients with chronic obstructive pulmonary disease and acute respiratory failure.  Anesthesiology. 1997;  86 (1) 79-91
    CrossrefPubMedSearch in Google Scholar
  • 34 Gay P C, Hess D, Hill N S. Randomized prospective trial of non-invasive pressure support ventilation and proportional pressure ventilation to treat acute respiratory insufficiency.  Am J Respir Crit Care Med. 1999;  159 A14
    PubMedSearch in Google Scholar
  • 35 Meecham Jones D J, Paul E A, Grahame-Clarke C, Wedzicha J A. Nasal ventilation in acute exacerbations of chronic obstructive pulmonary disease: effect of ventilator mode on arterial blood gas tensions.  Thorax. 1994;  49 (12) 1222-1224
    PubMedSearch in Google Scholar
  • 36 Navalesi P, Fanfulla F, Frigerio P, Gregoretti C, Nava S. Physiologic Evaluation of Noninvasive Mechanical Ventilation Delivered with Three Types of Mask in Patients with Chronic Hypercapnic Respiratory Failure.  Crit Care Med. 2000;  28 (6) 1785-1790
    CrossrefPubMedSearch in Google Scholar
  • 37 Vitacca M, Rubini F, Foglio K, Scalvini S, Nava S, Ambrosino N. Non-invasive modalities of positive pressure ventilation improve the outcome of acute exacerbations in COLD patients.  Intensive Care Med. 1993;  19 (8) 450-455
    CrossrefPubMedSearch in Google Scholar
  • 38 Soo Hoo G W, Santiago S, Williams A J. Nasal mechanical ventilation for hypercapnic respiratory failure in chronic obstructive pulmonary disease: determinants of success and failure.  Crit Care Med. 1994;  22 (8) 1253-1261
    CrossrefPubMedSearch in Google Scholar
  • 39 Chevrolet J C, Jolliet P, Abajo B, Toussi A, Louis M. Nasal positive pressure ventilation in patients with acute respiratory failure. Difficult and time-consuming procedure for nurses.  Chest. 1991;  100 (3) 775-782
    PubMedSearch in Google Scholar
  • 40 Confalonieri M, Potena A, Carbone G, Porta R D, Tolley E A, Umberto Meduri G. Acute respiratory failure in patients with severe community-acquired pneumonia. A prospective randomized evaluation of noninvasive ventilation.  Am J Respir Crit Care Med. 1999;  160 (5 Pt 1) 1585-1591
    PubMedSearch in Google Scholar
  • 41 Nava S, Evangelisti I, Rampulla C, Compagnoni M L, Fracchia C, Rubini F. Human and financial costs of noninvasive mechanical ventilation in patients affected by COPD and acute respiratory failure.  Chest. 1997;  111 (6) 1631-1638
    CrossrefPubMedSearch in Google Scholar
  • 42 Wood K A, Lewis L, Von Harz B, Kollef M H. The use of noninvasive positive pressure ventilation in the emergency department: results of a randomized clinical trial.  Chest. 1998;  113 (5) 1339-1346
    CrossrefPubMedSearch in Google Scholar
  • 43 Schönhofer B. Respiratory high-dependency units in Germany.  Monaldi Arch Chest Dis. 1999;  54 (5) 448-451
    PubMedSearch in Google Scholar
  • 44 Plant P K, Owen J L, Elliott M W. Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial.  Lancet. 2000;  355 1931-1935
    CrossrefPubMedSearch in Google Scholar
  • 45 Wysocki M, Tric L, Wolff M A, Millet H, Herman B. Noninvasive pressure support ventilation in patients with acute respiratory failure. A randomized comparison with conventional therapy.  Chest. 1995;  107 (3) 761-768
    CrossrefPubMedSearch in Google Scholar
  • 46 Antonelli M, Conti G, Bufi M. et al . Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial.  JAMA. 2000;  283 (2) 235-241
    CrossrefPubMedSearch in Google Scholar
  • 47 Rasanen J, Vaisanen I T, Heikkila J, Nikki P. Acute myocardial infarction complicated by left ventricular dysfunction and respiratory failure. The effects of continuous positive airway pressure.  Chest. 1985;  87 (2) 158-162
    PubMedSearch in Google Scholar
  • 48 Rusterholtz T, Kempf J, Berton C. et al . Noninvasive pressure support ventilation (NIPSV) with face mask in patients with acute cardiogenic pulmonary edema (ACPE).  Intensive Care Med. 1999;  25 (1) 21-28
    CrossrefPubMedSearch in Google Scholar
  • 49 Girault C, Daudenthun I, Chevron V, Tamion F, Leroy J, Bonmarchand G. Noninvasive ventilation as a systematic extubation and weaning technique in acute-on-chronic respiratory failure: a prospective, randomized controlled study.  Am J Respir Crit Care Med. 1999;  160 (1) 86-92
    PubMedSearch in Google Scholar
  • 50 Schönhofer B, Sonneborn M, Haidl P, Kemper K, Köhler D. Stellenwert der intermittierenden Selbstbeatmung nach Entwöhnung vom Respirator.  Pneumologie. 1995;  49 (12) 689-694
    PubMedSearch in Google Scholar
  • 51 Schönhofer B, Haidl P, Kemper P, Köhler D. Entwöhnung vom Respirator („Weaning”) bei Langzeitbeatmung.  Dtsch Med Wochenschr. 1999;  124 1022-1028
    Thieme ConnectPubMedSearch in Google Scholar
  • 52 Hilbert G, Gruson D, Portel L, Gbikpi-Benissan G, Cardinaud J P. Noninvasive pressure support ventilation in COPD patients with postextubation hypercapnic respiratory insufficiency.  Eur Respir J. 1998;  11 (6) 1349-1353
    CrossrefPubMedSearch in Google Scholar
  • 53 Jiang J S, Kao S J, Wang S N. Effect of early application of biphasic positive airway pressure on the outcome of extubation in ventilator weaning.  Respirology. 1999;  4 (2) 161-165
    CrossrefPubMedSearch in Google Scholar
  • 54 Benhamou D, Girault C, Faure C, Portier F, Muir J F. Nasal mask ventilation in acute respiratory failure. Experience in elderly patients.  Chest. 1992;  102 (3) 912-917
    CrossrefPubMedSearch in Google Scholar
  • 55 Meduri G U, Fox R C, Abou-Shala N, Leeper K V, Wunderink R G. Noninvasive mechanical ventilation via face mask in patients with acute respiratory failure who refused endotracheal intubation.  Crit Care Med. 1994;  22 (10) 1584-1590
    CrossrefPubMedSearch in Google Scholar
  • 56 Meduri G U, Turner R E, Abou-Shala N, Wunderink R, Tolley E. Noninvasive positive pressure ventilation via face mask. First-line intervention in patients with acute hypercapnic and hypoxemic respiratory failure.  Chest. 1996;  109 (1) 179-193
    CrossrefPubMedSearch in Google Scholar
  • 57 Schönhofer B, Köhler D. Therapeutische Strategien der ventilatorischen Insuffizienz bei amyotropher Lateralsklerose.  Nervenarzt. 1998;  69 (4) 312-319
    CrossrefPubMedSearch in Google Scholar
  • 58 Aguilo R, Togores B, Pons S, Rubi M, Barbe F, Agusti A G. Noninvasive ventilatory support after lung resectional surgery.  Chest. 1997;  112 (1) 117-121
    PubMedSearch in Google Scholar
  • 59 Gust R, Gottschalk A, Schmidt H, Bottiger B W, Martin E. Effects of continuous (CPAP) and bi-level positive airway pressure (BiPAP) on extravascular lung water after extubation of the trachea in patients following coronary artery bypass grafting.  Intensive Care Med. 1996;  22 (12) 1345-1350
    PubMedSearch in Google Scholar
  • 60 Kilger E, Briegel J, Haller M. et al . Effects of noninvasive positive pressure ventilatory support in non-COPD patients with acute respiratory insufficiency after early extubation.  Intensive Care Med. 1999;  25 (12) 1374-1380
    CrossrefPubMedSearch in Google Scholar
  • 61 Joris J L, Sottiaux T M, Chiche J D, Desaive C J, Lamy M L. Effect of bi-level positive airway pressure (BiPAP) nasal ventilation on the postoperative pulmonary restrictive syndrome in obese patients undergoing gastroplasty.  Chest. 1997;  111 (3) 665-670
    CrossrefPubMedSearch in Google Scholar
  • 62 Jousela I, Rasanen J, Verkkala K, Lamminen A, Makelainen A, Nikki P. Continuous positive airway pressure by mask in patients after coronary surgery.  Acta Anaesthesiol Scand. 1994;  38 (4) 311-316
    CrossrefPubMedSearch in Google Scholar
  • 63 Matte P, Jacquet L, Van Dyck M, Goenen M. Effects of conventional physiotherapy, continuous positive airway pressure and non-invasive ventilatory support with bilevel positive airway pressure after coronary artery bypass grafting.  Acta Anaesthesiol Scand. 2000;  44 (1) 75-81
    CrossrefPubMedSearch in Google Scholar
  • 64 Norregaard O, Jensen T M, Vindelev P. Effects of inspiratory pressure support on oxygenation and central haemodynamics in the normal heart during the postoperative period.  Respir Med. 1996;  90 (7) 415-417
    PubMedSearch in Google Scholar
  • 65 Pinilla J C, Oleniuk F H, Tan L. et al . Use of a nasal continuous positive airway pressure mask in the treatment of postoperative atelectasis in aortocoronary bypass surgery.  Crit Care Med. 1990;  18 (8) 836-840
    PubMedSearch in Google Scholar
  • 66 Stock M C, Downs J B, Gauer P K, Alster J M, Imrey P B. Prevention of postoperative pulmonary complications with CPAP, incentive spirometry, and conservative therapy.  Chest. 1985;  87 (2) 151-157
    CrossrefPubMedSearch in Google Scholar

Dr. med Bernd Schönhofer

Krankenhaus Kloster GrafschaftZentrum für Pneumologie und Allergologie

57392 Schmallenberg

Email: E-mail: Bernd.Schoenhofer@t-online.de