Prolongiertes Weaning bei Patienten mit ARDS

Stephan Braune; Bernd Schönhofer

doi:10.1055/s-0042-109194

DMW - Deutsche Medizinische Wochenschrift, Table of Contents

Dtsch Med Wochenschr 2017; 142(02): 102-109
DOI: 10.1055/s-0042-109194

Dossier

Prolongiertes Weaning bei Patienten mit ARDS

Prolonged Weaning in Patients with ARDS

Stephan Braune

,

Bernd Schönhofer

Abstract

The clinical course of moderate to severe ARDS often leads to prolonged weaning. Prolonged weaning utilizes considerable resources in intensive care medicine and is associated with a high mortality. The pathophysiology of prolonged weaning is complex and its understanding mandatory for its successful management. This article discusses and summarizes the most important causes of prolonged weaning and the corresponding treatment strategies to liberate patients with ARDS from the ventilator.

Ein mittelschweres und schweres ARDS führt häufig zu einer verlängerten Entwöhnung vom Beatmungsgerät. Dieses prolongierte Weaning beansprucht eine bedeutende Menge intensivmedizinischer Ressourcen und ist mit einer hohen Mortalität verbunden. Die Pathophysiologie des prolongierten Weaning ist komplex und das Verständnis hierfür entscheidend für den Weaning-Erfolg. Dazu gehören Kenntnisse über mögliche Ursachen des prolongierten Weanings und therapeutische Ansätze zur Entwöhnung der Patienten mit ARDS vom Beatmungsgerät.

Schlüsselwörter

ARDS - prolongiertes Weaning - FVIDD - ICU-AW - Sedierung - Frühmobilisierung

Key words

ARDS - prolonged weaning - VIDD - sedation - early mobilisation - geriatric assessment

Full Text

References

Literatur
1 Ranieri VM. Rubenfeld GD. Thompson BT. et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012; 307: 2526-2533
2 Bellani G. Laffey JG. Pham T. et al. Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries. JAMA 2016; 315: 788-800
3 Boles JM. Bion J. Connors A. et al. Weaning from mechanical ventilation. Eur Respir J 2007; 29: 1033-1056
4 Schönhofer B. Geiseler J. Dellweg D. et al. Prolongiertes Weaning: S2k-Leitlinie. Pneumologie 2014; 68: 19-75
5 Beduneau G. Pham T. Schortgen F. et al. Epidemiology of Weaning Outcome According to a New Definition. The WIND Study. Am J Respir Crit Care Med
6 Schönhofer B. Euteneuer S. Nava S. et al. Survival of mechanically ventilated patients admitted to a specialised weaning centre. Intensive Care Med 2002; 28: 908-916
7 Esteban A. Alia I. Ibanez J. et al. Modes of mechanical ventilation and weaning. A national survey of Spanish hospitals. The Spanish Lung Failure Collaborative Group. Chest 1994; 106: 1188-1193
8 Tremblay LN. Slutsky AS. Ventilator-induced lung injury: from the bench to the bedside. Intensive Care Med 2006; 32: 24-33
9 Melsen WG. Rovers MM. Bonten MJ. Ventilator-associated pneumonia and mortality: a systematic review of observational studies. Crit Care Med 2009; 37: 2709-2718
10 Dres M. Dube BP. Mayaux J. et al. Coexistence and Impact of Limb Muscle and Diaphragm Weakness at Time of Liberation From Mechanical Ventilation in Medical ICU Patients. Am J Respir Crit Care Med
11 Hermans G. Van den Berghe G. Clinical review: intensive care unit acquired weakness. Crit Care 2015; 19: 274
12 Hermans G. Van MH. Clerckx B. et al. Acute outcomes and 1-year mortality of intensive care unit-acquired weakness. A cohort study and propensity-matched analysis. Am J Respir Crit Care Med 2014; 190: 410-420
13 Kabitz HJ. Windisch W. Schönhofer B. Ventilator induzierter Zwerchfellschaden: ein Update. Pneumologie 2013; 67: 435-441
14 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
15 Kress JP. Hall JB. ICU-acquired weakness and recovery from critical illness. N Engl J Med 2014; 370: 1626-1635
16 Bein T. Grasso S. Moerer O. et al. The standard of care of patients with ARDS: ventilatory settings and rescue therapies for refractory hypoxemia. Intensive Care Med 2016; 42: 699-711
17 Doorduin J. Sinderby CA. Beck J. et al. Assisted Ventilation in Patients with Acute Respiratory Distress Syndrome: Lung-distending Pressure and Patient-Ventilator Interaction. Anesthesiology 2015; 123: 181-190
18 Saddy F. Sutherasan Y. Rocco PR. et al. Ventilator-associated lung injury during assisted mechanical ventilation. Semin Respir Crit Care Med 2014; 35: 409-417
19 Papazian L. Forel JM. Gacouin A. et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med 2010; 363: 1107-1116
20 Hraiech S. Yoshida T. Papazian L. Balancing neuromuscular blockade versus preserved muscle activity. Curr Opin Crit Care 2015; 21: 26-33
21 Alhazzani W. Alshahrani M. Jaeschke R. et al. Neuromuscular blocking agents in acute respiratory distress syndrome: a systematic review and meta-analysis of randomized controlled trials. Crit Care 2013; 17: R43
22 Baron R. Binder A. Biniek R. et al. S3-Leitlinie Analgesie, Sedierung und Delirmanagement in der Intensivmedizin. Revision 2015 (DAS-Leitlinie 2015) Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015). Ger Med Sci 2015; 13: Doc19
23 Mehta S. Burry L. Cook D. et al. Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol: a randomized controlled trial. JAMA 2012; 308: 1985-1992
24 Strom T. Martinussen T. Toft P. A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. Lancet 2010; 375: 475-480
25 Meduri GU. Schwingshackl A. Hermans G. Prolonged Glucocorticoid Treatment in ARDS: Impact on Intensive Care Unit-Acquired Weakness. Front Pediatr 2016; 4: 69
26 Wiedemann HP. Wheeler AP. Bernard GR. et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 2006; 354: 2564-2575
27 Schweickert WD. Pohlman MC. Pohlman AS. et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 2009; 373: 1874-1882
28 Hashem MD. Nelliot A. Needham DM. Early Mobilization and Rehabilitation in the ICU: Moving Back to the Future. Respir Care 2016; 61: 971-979
29 Jubran A. Grant BJ. Duffner LA. et al. Effect of pressure support vs unassisted breathing through a tracheostomy collar on weaning duration in patients requiring prolonged mechanical ventilation: a randomized trial. JAMA 2013; 309: 671-677
30 Kluge S. Baumann HJ. Maier C. et al. Tracheostomy in the intensive care unit: a nationwide survey. Anesth Analg 2008; 107: 1639-1643
31 Young D. Harrison DA. Cuthbertson BH. et al. Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: the TracMan randomized trial. JAMA 2013; 309: 2121-2129
32 Andriolo BN. Andriolo RB. Saconato H. et al. Early versus late tracheostomy for critically ill patients. Cochrane Database Syst Rev 2015; 1
33 Siempos II. Ntaidou TK. Filippidis FT. et al. Effect of early versus late or no tracheostomy on mortality and pneumonia of critically ill patients receiving mechanical ventilation: a systematic review and meta-analysis. Lancet Respir Med 2015; 3: 150-158
34 Simon M. Metschke M. Braune SA. et al. Death after percutaneous dilatational tracheostomy: a systematic review and analysis of risk factors. Crit Care 2013; 17: R258
35 Schönhofer B. Kluge S. Consequences of Endotracheal Intubation and Tracheostomy. In: Stevens RD. Hart N. Herridge MS. (eds) Textbook of Post-ICU Medicine: The Legacy of Critical Care. 2014: 180-194
36 Burns KE. Meade MO. Premji A. et al. Noninvasive ventilation as a weaning strategy for mechanical ventilation in adults with respiratory failure: a Cochrane systematic review. CMAJ 2014; 186: E112-E122
37 Ferrer M. Sellares J. Valencia M. et al. Non-invasive ventilation after extubation in hypercapnic patients with chronic respiratory disorders: randomised controlled trial. Lancet 2009; 374: 1082-1088
38 Lai YC. Ruan SY. Huang CT. et al. Hemoglobin levels and weaning outcome of mechanical ventilation in difficult-to-wean patients: a retrospective cohort study. PLoS One 2013; 8: e73743
39 Schönhofer B. Böhrer H. Köhler D. Blood transfusion facilitating difficult weaning from the ventilator. Anaesthesia 1998; 53: 181-184
40 Schönhofer B. Wenzel M. Geibel M. et al. Blood transfusion and lung function in chronically anemic patients with severe chronic obstructive pulmonary disease. Crit Care Med 1998; 26: 1824-1828
41 Moerer O. Barwing J. Quintel M. Neurally adjusted ventilatory assist (NAVA). Eine eine neue assistierte Beatmungsform [Neurally adjusted ventilatory assist (NAVA). A new mode of assisted mechanical ventilation]. Anaesthesist 2008; 57: 998-1005
42 Di MR. Spadaro S. Mirabella L. et al. Impact of prolonged assisted ventilation on diaphragmatic efficiency: NAVA versus PSV. Crit Care 2016; 20: 1
43 Frat JP. Thille AW. Mercat A. et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med 2015; 372: 2185-2196
44 Stephan F. Barrucand B. Petit P. et al. High-Flow Nasal Oxygen vs Noninvasive Positive Airway Pressure in Hypoxemic Patients After Cardiothoracic Surgery: A Randomized Clinical Trial. JAMA 2015; 313: 2331-2339
45 Sklar MC. Beloncle F. Katsios CM. et al. Extracorporeal carbon dioxide removal in patients with chronic obstructive pulmonary disease: a systematic review. Intensive Care Med 2015; 41: 1752-1762
46 Braune S. Sieweke A. Brettner F. et al. The feasibility and safety of extracorporeal carbon dioxide removal to avoid intubation in patients with COPD unresponsive to noninvasive ventilation for acute hypercapnic respiratory failure (ECLAIR study): multicentre case-control study. Intensive Care Med 2016; 42: 1437-1444
47 Bein T. Weber-Carstens S. Goldmann A. et al. Lower tidal volume strategy (approximately 3 ml/kg) combined with extracorporeal CO2 removal versus 'conventional' protective ventilation (6 ml/kg) in severe ARDS: the prospective randomized Xtravent-study. Intensive Care Med 2013; 39: 847-856
48 Schönhofer B. Geiseler J. Pfeifer M. et al. WeanNet: Das Netztwerk pneumologischer Weaninzentren. Pneumologie 2014; 68: 737-742
49 WeanNet. Das Netzwerk von Weaning-Einheiten der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Epidemiologie und Outcome bei Patienten im prolongierten Weaning. Dtsch Med Wochenschr 2016; 141: e166-e172
50 Chiumello D. Coppola S. Froio S. et al. What's Next After ARDS: Long-Term Outcomes. Respir Care 2016; 61: 689-699
51 Pfoh ER. Wozniak AW. Colantuoni E. et al. Physical declines occurring after hospital discharge in ARDS survivors: a 5-year longitudinal study. Intensive Care Med 2016; 42: 1557-1566
52 Herridge MS. Moss M. Hough CL. et al. Recovery and outcomes after the acute respiratory distress syndrome (ARDS) in patients and their family caregivers. Intensive Care Med 2016; 42: 725-738