Nicht-invasive außerklinische Beatmung: Pathophysiologie, Einstellung und Kontrolle

Die nichtinvasive Beatmung (NIV) kann effektiv das Typ-II-hyperkapnische Atemversagen therapieren. Vor allem bei Patienten mit chronisch-obstruktiven oder thorakal-restriktiven Lungenerkrankungen oder neuromuskulären Erkrankungen liegt der Hyperkapnie eine chronisch oder akut geschwächte Atemmuskelpumpe zugrunde. Der Beitrag erklärt die relevanten Befunde sowie Indikation, Einleitung und Verlaufskontrollen der NIV.

Abstract

COPD is the most common reason for hypercapnia. However, it is – by far – not the only reason. In fact, numerous neuromuscular disorders (not only ALS) as well as restrictive thoracic disorders do also lead to clinically highly relevant hypercapnia. Early diagnosis of hypercapnic ventilatory failure usually takes place at nighttime. NIV devices work with a periodic interplay of alternating IPAP and EPAP which results in a ventilation of the lungs, thereby elimination CO₂ to treat hypercapnic respiratory failure. Firstline settings for a NIV therapy to treat “stable hypercapnia” are as follows: Pressure Support Ventilation Modus, EPAP 5 cm H₂O, IPAP 15 cm H₂O, Back Up rate 15/Minute. The overall goal of NIV treatment is a successful reduction in CO₂. This can be achieved by changing the following variables of the ventilator settings: increase in IPAP ± increase in back up respiratory rate ± use of assisted pressure controlled ventilation mode (APCV)–.

Schlüsselwörter

Nicht invasive Beatmung - Pneumologie - COPD - neuromuskuläre Erkrankungen

Keywords

non-invasive ventilation - pneumology - COPD - neuromuscular disorders

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