Download PDF
Dtsch Med Wochenschr 2017; 142(16): 1197-1204
DOI: 10.1055/s-0042-121787
Dossier
© Georg Thieme Verlag KG Stuttgart · New York

Außerklinische Beatmung – Konzepte und Therapieempfehlungen

Home mechanical Ventilation – Concepts and Therapy Recommendations
Sarah Bettina Schwarz
,
Friederike Sophie Magnet
,
Bernd Schönhofer
,
Wolfram Windisch
Further Information

Publication History

Publication Date:
15 August 2017 (online)

Also available at
    Permissions and Reprints

Abstract

The prognosis of patients receiving home mechanical ventilation is very heterogeneous and depends on the underlying disease, the degree of respiratory dependency and the comorbidities. Due to the severe chronic diseases, the initiation of a long-term NIV must be done during an inpatient treatment. Two recently published randomized controlled trials using more aggressive forms of NPPV targeted at normalizing hypercapnic PaCO2 values, showed improved long term survival also in patients with an underlying diagnosis of COPD. Consequently, the number of patients receiving home mechanical ventilation has dramatically increased in recent years and more and more outpatient settings has been established without scientific evidence. Nevertheless, beside reliable care structures, ethical aspects and health related quality of life are of great importance in the context of home mechanical ventilation.

Die außerklinische Beatmung hat sich in den letzten Jahren zu einem Schwerpunkt in der Pneumologie entwickelt. Mittlerweile gehört sie zum therapeutischen Standard bei der Versorgung von Patienten mit chronischer ventilatorischer Insuffizienz. Der vorliegende Beitrag fasst die aktuelle Evidenz zur außerklinischen Beatmung zusammen und nimmt Bezug auf die damit verbundenen medizinischen, ethischen und ökonomischen Herausforderungen.

Schlüsselwörter

Chronisch ventilatorische Insuffizienz - COPD - Langzeit-NIV - Lebensqualität

Key words

chronic ventilatory insufficiency - COPD - long-term NIV - quality of life
 

  • Literatur

  • 1 Windisch W. Chronische respiratorische Insuffizienz: Rolle der außerklinischen Beatmung. Pneumologie 2010; 64: 600-603
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Simonds AK. Home mechanical ventilation: an overview. Annals of the American Thoracic Society 2016; 13: 2035-2044
    CrossrefPubMedGoogle Scholar
  • 3 Huttmann SE, Storre JH, Windisch W. Außerklinische Beatmung: invasive und nichtinvasive Beatmungstherapie bei chronischer ventilatorischer Insuffizienz. Der Anaesthesist 2015; 64: 479-488
    CrossrefPubMedGoogle Scholar
  • 4 Huttmann SE, Windisch W, Storre JH. Techniques for the measurement and monitoring of carbon dioxide in the blood. Annals of the American Thoracic Society 2014; 11: 645-652
    CrossrefPubMedGoogle Scholar
  • 5 West JB. The physiological challenges of the 1952 copenhagen poliomyelitis epidemic and a renaissance in clinical respiratory physiology. Journal of Applied Physiology 2005; 99: 424-432
    CrossrefPubMedGoogle Scholar
  • 6 Windisch W, Brambring J, Budweiser S. et al. Nichtinvasive und invasive Beatmung als Therapie der chronischen respiratorischen Insuffizienz. Pneumologie 2010; 64: 207-240
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Windisch W, Brambring J, Dellweg D. et al. Nichtinvasive und invasive Beatmung als Therapie der chronischen respiratorischen Insuffizienz. Revidierte S2k-Leitlinie herausgegeben von der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin e.V. 2017 in Vorbereitung
    PubMedGoogle Scholar
  • 8 Windisch W, Criée CP. Pathophysiologie und Grundlagen des respiratorischen Versagens. Der Pneumologe 2010; 7: 74-80
    CrossrefPubMedGoogle Scholar
  • 9 Windisch W, Schönhofer B, Magnet FS. et al. Diagnostik und Therapie der gestörten Zwerchfellfunktion. Pneumologie 2016; 70: 454-461
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Schönhofer B. Nichtinvasive Beatmung beim Patienten mit persistierender Hyperkapnie. Med Klin Intensivmed Notfmed 2015; 110: 182-187
    CrossrefPubMedGoogle Scholar
  • 11 Callegari J, Windisch W, Storre J. Überleitung in die außerklinische invasive Beatmung. Intensivmedizin up2date 2015; 11: 321-331
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Schönhofer B. Das pneumologische Beatmungszentrum – alles unter einem Dach. Pneumologie 2008; 62: 340-352
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Schönhofer B, Sortor-Leger S. Equipment needs for noninvasive mechanical ventilation. European Respiratory Journal 2002; 20: 1029-1036
    CrossrefPubMedGoogle Scholar
  • 14 Criner GJ, Brennan K, Travaline JM. et al. Efficacy and compliance with noninvasive positive pressure ventilation in patients with chronic respiratory failure. Chest 1999; 116: 667-675
    CrossrefPubMedGoogle Scholar
  • 15 Schönhofer B, Barchfeld T, Wenzel M. et al. Long-term effects of non-invasive mechanical ventilation on pulmonary hemodynamics in patients with chronic respiratory failure. Thorax 2001; 56: 524-528
    CrossrefPubMedGoogle Scholar
  • 16 Schönhofer B, Wallstein S, Wiese C. et al. Noninvasive Mechanical Ventilation improves endurance performance in patients with chronic respiratory failure due to thoracic restriction. Chest 2001; 119: 1371-1378
    CrossrefPubMedGoogle Scholar
  • 17 Schönhofer B, Zimmermann C, Abramek P. et al. Non-invasive mechanical ventilation improves walking distance but not quadriceps strength in chronic respiratory failure. Respiratory Medicine 2003; 7: 818-824
    PubMedGoogle Scholar
  • 18 Schönhofer B, Köhler D. Effect of non-invasive mechanical ventilation on sleep and nocturnal ventilation in chronic respiratory failure. Thorax 2000; 55: 308-314
    CrossrefPubMedGoogle Scholar
  • 19 Köhnlein T, Windisch W, Köhler D. et al. Non-invasive positive pressure ventilation for the treatment of severe stable chronic obstructive pulmonary disease: a prospective, multicentre, randomised, controlled clinical trial. The Lancet Respiratory Medicine 2014; 2: 698-705
    CrossrefPubMedGoogle Scholar
  • 20 Simonds AK, Elliott MW. Outcome of domiciliary nasal intermittent positive pressure ventilation in restrictive and obstructive disorders. Thorax 1995; 50: 604-609
    CrossrefPubMedGoogle Scholar
  • 21 Leger P, Marie Bedicam J, Cornette A. et al. Nasal intermittent positive pressure ventilation. Chest 1994; 105: 100-105
    CrossrefPubMedGoogle Scholar
  • 22 Windisch W, Criée C. Lebensqualität bei Patienten mit häuslicher Beatmung. Pneumologie 2006; 60: 539-546
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Windisch W. on behalf of the quality of life in home mechanical ventilation study group. Impact of home mechanical ventilation on health-related quality of life. European Respiratory Journal 2008; 32: 1328-1336
    CrossrefPubMedGoogle Scholar
  • 24 Windisch W, Freidel K, Schucher B. et al. The severe respiratory insufficiency (SRI) questionnaire a specific measure of health-related quality of life in patients receiving home mechanical ventilation. Journal of Clinical Epidemiology 2003; 56: 752-759
    CrossrefPubMedGoogle Scholar
  • 25 Windisch W, Budweiser S, Heinemann F. et al. The severe respiratory insufficiency questionnaire was valid for COPD patients with severe chronic respiratory failure. Journal of Clinical Epidemiology 2008; 61: 848-853
    CrossrefPubMedGoogle Scholar
  • 26 Casanova C, Celli BR, Tost L. et al. Long-term controlled trial of nocturnal nasal positive pressure ventilation in patients with severe COPD. Chest 2000; 118: 1582-1590
    CrossrefPubMedGoogle Scholar
  • 27 Clini E, Sturani C, Rossi A. et al. The italian multicentre study on noninvasive ventilation in chronic obstructive pulmonary disease patients. European Respiratory Journal 2002; 20: 529-538
    CrossrefPubMedGoogle Scholar
  • 28 Struik FM, Lacasse Y, Goldstein R. et al. Nocturnal non-invasive positive pressure ventilation for stable chronic obstructive pulmonary disease. In Cochrane Database of Systematic Reviews, Hrsg. The Cochrane Collaboration 2013
    PubMedGoogle Scholar
  • 29 Dreher M, Storre JH, Schmoor C. et al. High-intensity versus low-intensity non-invasive ventilation in patients with stable hypercapnic COPD: a randomised crossover trial. Thorax 2010; 65: 303-308
    CrossrefPubMedGoogle Scholar
  • 30 Windisch W, Kostić S, Dreher M. et al. Outcome of patients with stable COPD receiving controlled noninvasive positive pressure ventilation aimed at a maximal reduction of paCO2 . Chest 2005; 128: 657-662
    CrossrefPubMedGoogle Scholar
  • 31 Murphy PB, Rehal S, Arbane G. et al. Effect of Home Noninvasive Ventilation With Oxygen Therapy vs Oxygen Therapy Alone on Hospital Readmission or Death After an Acute COPD Exacerbation: A Randomized Clinical Trial. JAMA 2017; 317: 2177-2186.
    CrossrefPubMedGoogle Scholar
  • 32 Schönhofer B, Geiseler J, Dellweg D. et al. S2k-Leitlinie Prolongiertes Weaning. Pneumologie 2014; 68: 19-75
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Huttmann SE, Windisch W, Storre JH. Invasive home mechanical ventilation: Health-Related quality of life. Respiration 2015; 89: 312-321
    CrossrefPubMedGoogle Scholar
  • 34 Geiseler J, Karg O, Börger S. et al. Invasive Heimbeatmung insbesondere bei neuromuskulären Erkrankungen. Deutsches Institut für Medizinische Dokumentation und Information (DIMDI) 2010; 5-21 +106
    PubMedGoogle Scholar
  • 35 Schönhofer B, Euteneuer S, Nava S. et al. Survival of mechanically ventilated patients admitted to a specialized weaning centre. Intensive Care Medicine 2002; 28: 908-916
    CrossrefPubMedGoogle Scholar
  • 36 Ballotta A, Kandil H, Generali T. et al. Tracheostomy after cardiac operations: in-hospital and long-term survival. The Annals of Thoracic Surgery 2011; 92: 528-533
    CrossrefPubMedGoogle Scholar
  • 37 Chatwin M, Nickol AH, Morrell MJ. et al. Randomised trial of inpatient versus outpatient initiation of home mechanical ventilation in patients with nocturnal hypoventilation. Respiratory Medicine 2008; 102: 1528-1535
    CrossrefPubMedGoogle Scholar
  • 38 Randerath W, Kamps N, Brambring J. et al. Durchführungsempfehlungen zur invasiven außerklinischen Beatmung. Pneumologie 2011; 65: 72-88
    Article in Thieme ConnectPubMedGoogle Scholar
  • 39 Schönhofer B, Köhler D, Kutzer K. Ethische Betrachtungen zur Beatmungsmedizin unter besonderer Berücksichtigung des Lebensendes. Pneumologie 2006; 60: 408-416
    Article in Thieme ConnectPubMedGoogle Scholar
  • 40 Geiseler J, Schönhofer B. Ethik und Palliativmedizin in Intensiv- und Beatmungsmedizin. Der Pneumologe 2016; 13: 104-112
    CrossrefPubMedGoogle Scholar
  • 41 Janssens U, Burchardi N, Duttge G. et al. Therapiezieländerung und Therapiebegrenzung in der Intensivmedizin. DIVI 2012; 3: 103-107
    PubMedGoogle Scholar
  • 42 Schönhofer B, Janssens U. Ethische Entscheidungskonflikte in der Intensivmedizin bei pulmonalen Erkrankungen und Therapien. Salomon F. Hrsg Praxisbuch Ethik in der Intensivmedizin. 3. Auflage. Berlin: Med. Wiss. Verlagsgesellschaft; 2017
    Google Scholar
  • 43 Schönhofer B, Köhler D. Beatmungsmedizin. In: May AT, Kreß H. et al. (Hrsg) Patientenverfügungen. Heidelberg: Springer; 2016: 225-234
    CrossrefGoogle Scholar