Beatmungsstrategien in der Intensivmedizin

Die Beatmungstherapie ist für viele Patienten eine lebensrettende Intervention, die einen suffizienten pulmonalen Gasaustausch und eine adäquate Gewebeoxygenierung sicherstellt. Ein fundiertes physiologisches Verständnis und grundlegende Kenntnisse der Beatmungstechnik sind notwendig, um die jeweils optimale Form der differenzierten Lungenunterstützung auswählen und anwenden zu können.

Schlüsselwörter

Beatmung - Intensivmedizin - ARDS - akutes Lungenversagen

• Literatur

• 1 Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI). S3-Leitlinie Invasive Beatmung und Einsatz extrakorporaler Verfahren bei akuter respiratorischer Insuffizienz. AWMF Leitlinien-Register Nr. 001/021. 1. Auflage. Im Internet: https://www.awmf.org/leitlinien/detail/ll/001-021.html Stand: 20.12.2018
• 2 Bellani G, Laffey JG, Pham T. et al. The LUNG SAFE study: a presentation of the prevalence of ARDS according to the Berlin Definition!. Crit Care 2016; 20: 268
• 3 Isfort M. Einfluss der Personalausstattung auf Pflege und Patientenversorgung in deutschen Intensivstationen. Med Klin Intensivmed Notfmed 2013; 108: 71-77
• 4 Esteban A, Frutos-Vivar F, Muriel A. et al. Evolution of mortality over time in patients receiving mechanical ventilation. Am J Respir Crit Care Med 2013; 188: 220-230
• 5 Wunsch H, Linde-Zwirble WT, Angus DC. et al. The epidemiology of mechanical ventilation use in the United States. Crit Care Med 2010; 38: 1947-1953
• 6 Plataki M, Hubmayr RD. The physical basis of ventilator-induced lung injury. Expert Rev Respir Med 2010; 4: 373-385
• 7 Spieth PM, Bluth T, Gama De Abreu M. et al. Mechanotransduction in the lungs. Minerva Anestesiol 2014; 80: 933-941
• 8 Uhlig S. Ventilation-induced lung injury and mechanotransduction: stretching it too far?. Am J Physiol Lung Cell Mol Physiol 2002; 282: L892-896
• 9 Bhattacharya J, Matthay MA. Regulation and repair of the alveolar-capillary barrier in acute lung injury. Annu Rev Physiol 2013; 75: 593-615
• 10 Pelosi P, Rocco PR. Effects of mechanical ventilation on the extracellular matrix. Intensive Care Med 2008; 34: 631-639
• 11 Chacko B, Peter JV, Tharyan P. et al. Pressure-controlled versus volume-controlled ventilation for acute respiratory failure due to acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). Cochrane Database Syst Rev 2015; (01) CD008807
• 12 Hedenstierna G. Atelectasis formation and gas exchange impairment during anaesthesia. Monaldi Arch Chest Dis 1994; 49: 315-322
• 13 Levine S, Nguyen T, Taylor N. et al. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med 2008; 358: 1327-1335
• 14 Papazian L, Forel JM, Gacouin A. et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med 2010; 363: 1107-1116
• 15 Putensen C, Zech S, Wrigge H. et al. Long-term effects of spontaneous breathing during ventilatory support in patients with acute lung injury. Am J Respir Crit Care Med 2001; 164: 43-49
• 16 Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med 2013; 369: 2126-2136
• 17 Putensen C, Mutz NJ, 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
• 18 Spieth PM, Koch T, Gama de Abreu M. Approaches to ventilation in intensive care. Dtsch Arztebl Int 2014; 111: 714-720
• 19 Rose L, Schultz MJ, Cardwell CR. et al. Automated versus non-automated weaning for reducing the duration of mechanical ventilation for critically ill adults and children: a Cochrane systematic review and meta-analysis. Crit Care 2015; 19: 48
• 20 Mead J, Takishima T, Leith D. Stress distribution in lungs: a model of pulmonary elasticity. J Appl Physiol 1970; 28: 596-608
• 21 Acute Respiratory Distress Syndrome Network. Brower RG, Matthay MA, Morris A. et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000; 342: 1301-1308
• 22 Briel M, Meade M, Mercat A. et al. Higher vs. lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis. JAMA 2010; 303: 865-873
• 23 Writing Group for the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial I. Cavalcanti AB, Suzumura EA. et al. Effect of lung recruitment and titrated positive end-expiratory pressure (PEEP) vs. low PEEP on mortality in patients with acute respiratory distress syndrome: a randomized clinical trial. JAMA 2017; 318: 1335-1345
• 24 Talmor D, Sarge T, Malhotra A. et al. Mechanical ventilation guided by esophageal pressure in acute lung injury. N Engl J Med 2008; 359: 2095-2104