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Pneumologie 2006; 60(4): 248-257
DOI: 10.1055/s-2005-919161
Serie: Beatmungsmedizin (2)
© Georg Thieme Verlag Stuttgart · New York

Grundprinzipien und Arbeitsweise von Beatmungsmaschinen: Klassifikation und Modi

Principles and Function of Mechanical Ventilation: Classification and Modes of VentilatorsC.  Kelbel1 , M.  Huntemann1 , J.  Lorenz1
  • 1Innere 2, Pneumologie, Infektiologie, Schlafmedizin, Intensivmedizin, Direktor: Prof., Dr. J. Lorenz, Lüdenscheid
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Publication History

Publication Date:
03 April 2006 (online)

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Zusammenfassung

Verschiedenste Erkrankungen machen einen Ersatz oder eine Unterstützung der Atemtätigkeit eines Patienten notwendig. Dafür stehen Beatmungsmaschinen zur Verfügung. Die genaue Kenntnis der Arbeitsweise von Beatmungsmaschinen und eine sorgfältige Begriffsklärung reduziert die Beatmungsmedizin auf ein durchaus überschaubares Niveau, das es dem Anwender ermöglicht, die Beatmung an die jeweiligen Bedürfnisse des Patienten anzupassen. Die nachstehende Übersicht beschreibt die Funktionsweise von Beatmungsmaschinen und die Möglichkeiten der Anwendung, die sich daraus ergeben. Dabei werden die in der Beatmungsmedizin gängigen Begriffe erläutert und vielfach angewendete Modi vorgestellt.

Abstract

A spectrum of diseases is associated with the necessity for partial or total support of pulmonary ventilation. The insight into the function of ventilators and their modes reduces the spectrum of ventilatory support to a few basic principles. The knowledge enables the pulmonary intensivist to adapt mechanical ventilation to the individual patient's needs. This overview describes the technical aspects of mechanical ventilation and summarizes the variety of specific modes implied.

Literatur

  • 1 American Association for Respiratory Care . Consensus statement on the essentials of mechanical ventilators.  Respir Care. 1992;  37 1000-1008
    PubMedSearch in Google Scholar
  • 2 Branson R D, Chatburn R L. Technical description and classification of modes of ventilator operation.  Respir Care. 1992;  37 1026-1044
    PubMedSearch in Google Scholar
  • 3 Chatburn R L. Classification of mechanical ventilators.  Respir Care. 1992;  37 1009-1025
    PubMedSearch in Google Scholar
  • 4 Slutsky A S. ACCP consensus conference: Mechanical ventilation.  Chest. 1993;  104 1833-1859
    CrossrefPubMedSearch in Google Scholar
  • 5 Tobin J T. Mechanical Ventilation.  N Engl J Med. 1994;  330 1056-1061
    CrossrefPubMedSearch in Google Scholar
  • 6 Giuliani R, Mascia L, Recchia F. et al . Patient-ventilator interaction during synchronized intermittend mandatory ventilation.  Am J Respir Crit Care Med. 1995;  151 1-9
    PubMedSearch in Google Scholar
  • 7 Chatburn R L, Branson R D. Classification of mechanical ventilators. In: MacIntyre NR, Branson RD. Mechanical ventilation. Philadelphia, London, New York, St. Louis, Syndney, Toronto: W.B. Saunders Company 2001: 2-50
    Search in Google Scholar
  • 8 Day S, MacIntyre N R. Ventilator alarm systems.  Prob Respir Care. 1991;  4 118-126
    PubMedSearch in Google Scholar
  • 9 MacIntyre N R, Day S. Essentials for ventilator-alarm systems.  Respir Care. 1992;  37 1108-1112
    PubMedSearch in Google Scholar
  • 10 Esteban A, Alia I, Gordo F. et al . Prospective randomized trial comparing pressure-controlled ventilation and volume-controlled ventilation in ARDS.  Chest. 2000;  117 1690-1696
    CrossrefPubMedSearch in Google Scholar
  • 11 Branson R D. New modes of mechanical ventilation.  Curr Opinion Crit Care. 1999;  5 33-42
    PubMedSearch in Google Scholar
  • 12 Nightingale P. Pressure controlled ventilation - a true advance?.  Clin Intensive Care. 1994;  5 114-122
    PubMedSearch in Google Scholar
  • 13 Prella M, Feihl F, Domenighetti G. Effects of short-term pressure-controlled ventilation on gas exchange, airway pressure, and gas distribution in patients with acute lung injury/ARDS.  Chest. 2002;  122 1382-1388
    CrossrefPubMedSearch in Google Scholar
  • 14 Cohen A T, Parsloe M RJ. Modes of ventilation: SIMV for all?.  Intensive Care World. 1987;  4 58-62
    PubMedSearch in Google Scholar
  • 15 Heenan T J, Downs J B, Douglas M E. et al . Intermittent mandatory ventilation: is synchronisation important?.  Chest. 1980;  77 598-602
    PubMedSearch in Google Scholar
  • 16 Luce J M, Pierson D J, Hudson L D. Intermittend mandatory ventilation.  Chest. 1981;  79 678-685
    PubMedSearch in Google Scholar
  • 17 Weismann I M, Rinaldo J E, Rogers R M. et al . Intermittent mandatory ventilation.  Am Rev Respir Dis. 1983;  127 641-647
    PubMedSearch in Google Scholar
  • 18 Baum M, Benzer H, Putensen C. et al . Biphasic positive airway pressure (BIPAP) - eine neue Form der augmentierten Beatmung.  Anaesthesist. 1989;  38 452-458
    PubMedSearch in Google Scholar
  • 19 Hörmann C, Baum M, Putensen C. et al . Biphasic positive airway pressure (BIPAP) - a new mode of ventilatory support.  Eur J Anaesthseiol. 1994;  11 37-42
    PubMedSearch in Google Scholar
  • 20 Putensen C, Mutz N J, Putensen-Himmer G. et al . Spontaneous breathing during ventilatory support improves ventilation-perfusion distributions in patients with acute respiratory distress syndrome.  Am J Respir Crit Care Med. 1999;  159 1241-1248
    CrossrefPubMedSearch in Google Scholar
  • 21 Hewlett A M, Platt A S, Terry V G. Mandatory minute ventilation.  Anaesthesia. 1977;  32 163-169
    PubMedSearch in Google Scholar
  • 22 Sassoon C SH. Positive pressure ventilation: Alternate modes.  Chest. 1991;  100 1421-1429
    PubMedSearch in Google Scholar
  • 23 Brochard L. Inspiratory pressure support.  Eur J Anaesthesiol. 1994;  11 29-36
    PubMedSearch in Google Scholar
  • 24 Campell R S, Branson R D. Ventilatory support for the 90s: Pressure support ventilation.  Respir Care. 1993;  38 526-537
    PubMedSearch in Google Scholar
  • 25 Mols G, Ungern-Sternberg B von, Rohr E. et al . Respiratory comfort and breathing pattern during volume proportional assist ventilation and pressure support ventilation: a study on volunteers with artificially reduced compliance.  Crit Care Med. 2000;  28 1940-1946
    PubMedSearch in Google Scholar
  • 26 Tokioka H, Saito S, Kosaka F. Effect of pressure support ventilation on breathing pattern and respiratory work.  Intensive Care Med. 1989;  15 491-494
    CrossrefPubMedSearch in Google Scholar
  • 27 Vitacca M, Bianchi L, Zanotti E. et al . Assessment of physiologic variables and subjective comfort under different levels of pressure support ventilation.  Chest. 2004;  126 851-859
    CrossrefPubMedSearch in Google Scholar
  • 28 Cane R D, Peruzzi W T, Shapiro B A. Airway pressure release ventilation in severe acute respiratory failure.  Chest. 1991;  100 460-463
    CrossrefPubMedSearch in Google Scholar
  • 29 Downs J B, Stock M C. Airway pressure release ventilation: a new concept in ventilatory support.  Crit Care Med. 1987;  15 459-461
    CrossrefPubMedSearch in Google Scholar
  • 30 Florete O J, Banner M J, Banner T E. et al . Airway pressure release ventilation in a patient with acute pulmonary injury.  Chest. 1989;  96 679-682
    PubMedSearch in Google Scholar
  • 31 Putensen C, Zech S, Zinserling J. Effect of early spontaneous breathing during airway pressure release ventilation on cardiopulmonary function.  Am J Respir Crit Care Med. 1998;  157 A45
    PubMedSearch in Google Scholar
  • 32 Stock M C, Downs J B, Frohlicher D A. Airway pressure release ventilation.  Crit Care Med.. 1987;  15 462-466
    PubMedSearch in Google Scholar
  • 33 Sydow M, Burchardi H, Ephraim E. et al . Long term effects of two different ventilatory modes on oxygenation in acute lung injury. Comparison of airway pressure release ventilation and volume controlled inverse ratio ventilation.  Am J Respir Crit Care Med. 1994;  149 1550-1556
    PubMedSearch in Google Scholar
  • 34 Ambrosino N, Rossi A. Proportional assist ventilation (PAV): a significant advance or a futile struggle between logic and practice?.  Thorax. 2002;  57 272-276
    CrossrefPubMedSearch in Google Scholar
  • 35 Bigatello L M, Nishimura M, Imanaka H. et al . Unloading of the work of breathing by proportional assist ventilation in a lung model.  Crit Care Med. 1997;  25 267-272
    PubMedSearch in Google Scholar
  • 36 Marantz S, Patrick W, Webster K. et al . Response of ventilator-dependant patients to different levels of proportional assist ventilation.  J Appl Physiol. 1996;  80 397-403
    PubMedSearch in Google Scholar
  • 37 Navalesi P, Hernandez P, Wongsa A. et al . Proportional assist ventilation in acute respiratory failure: effects of breathing pattern and inspiratory effort.  Am J Respir Crit Care Med. 1996;  154 1330-1338
    PubMedSearch in Google Scholar
  • 38 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 79-81
    CrossrefPubMedSearch in Google Scholar
  • 39 Younes M. Proportional assist ventilation: a new approach to ventilatory support.  Am Rev Respir Dis. 1992;  45 114-120
    PubMedSearch in Google Scholar
  • 40 Younes M, Puddy A, Roberts D. et al . Proportional assist ventilation: Results of clinical trial.  Am Rev Respir Dis. 1992;  145 121-129
    CrossrefPubMedSearch in Google Scholar
  • 41 Guttmann J, Haberthür C, Mols G. et al . Automatic tube compensation (ATC).  Neth J Crit Care. 2002;  6 10-14
    PubMedSearch in Google Scholar
  • 42 Fabry B, Haberthür C, Zappe D. et al . Breathing pattern and additional work of breathing in spontaneously breathing patients with different ventilatory demands during inspiratory pressure support and automatic tube compensation.  Intensive Care Med. 1997;  23 545-552
    CrossrefPubMedSearch in Google Scholar
  • 43 Guttmann J, Bernhard H, Mols G. et al . Respiratory comfort of automatic tbe compensation and inspiratory pressure support in conscious humans.  Intensive Care Med. 1997;  23 1119-1124
    CrossrefPubMedSearch in Google Scholar
  • 44 Abraham E, Yoshihara G. Cardiorespiratory effects of pressure controlled inverse ratio ventilation in severe respiratory failure.  Chest. 1989;  96 1356-1359
    CrossrefPubMedSearch in Google Scholar
  • 45 Marcy T W, Marini J J. Inverse ratio ventilation in ARDS. Rationale and implement.  Chest. 1991;  100 494-504
    CrossrefPubMedSearch in Google Scholar
  • 46 Shanholtz C, Brower R. Should inverse ratio ventilation be used in adult respiratory distress syndrome?.  Am J Respir Crit Care. 1994;  149 1354-1358
    PubMedSearch in Google Scholar
  • 47 Derdak S, Metha S, Stewart T E. et al . The Multicenter Oscillatory Ventilation for Acute Respiratory Distress Syndrome Trial (MOAT) Study Investigators: High-Frequency Oscillatory Ventilation for acute Respiratory Distress Syndrome in Adults: A Randomized, Controlled Trial.  Am J Respir Crit Care Med. 2002;  166 801-808
    CrossrefPubMedSearch in Google Scholar
  • 48 Galvin I, Krishnamoorthy R, Saad R SG. Management of advanced ARDS complicated by bilateral pneumothoraces with high-frequency oscillatory ventilation in an adult.  Br J Anaesthesia. 2004;  93 (3) 454-456
    PubMedSearch in Google Scholar
  • 49 Ritacca F V, Stewart T E. High-frequency oscillatory ventilation in adults - a review of the literature and practical applications.  Crit Care. 2003;  7 (5) 385-390
    CrossrefPubMedSearch in Google Scholar
  • 50 Slutsky A S. High-frequency ventilation.  Intensive Care Med. 1991;  17 375-376
    CrossrefPubMedSearch in Google Scholar
  • 51 Smith B E. High-frequency ventilation: past, present and future.  Br J Anaesth. 1990;  65 130-138
    PubMedSearch in Google Scholar

Bereits publizierte Beiträge zu dieser Serie:

Dr. Clemens Kelbel

Innere 2, Pneumologie, Infektiologie, Schlafmedizin, Intensivmedizin

Paulmannshöher Str. 14

58515 Lüdenscheid

Email: Clemens.Kelbel@Klinikum-luedenscheid.de