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Pneumologie 2018; 72(02): 119-126
DOI: 10.1055/s-0043-110469
Serie: Schlafmedizin
© Georg Thieme Verlag KG Stuttgart · New York

Schlafbezogene Atmungsstörungen bei beatmungspflichtigen Patienten – Relevanz für das perioperative und das intensivmedizinische Management

Sleep Apnea and Mechanical Ventilation – Impact on Clinical Course and Perioperative Management
S. Keymel
1   Universitätsklinik Düsseldorf, Medizinische Fakultät, Klinik für Kardiologie, Pneumologie und Angiologie, Düsseldorf
,
S. Krüger
1   Universitätsklinik Düsseldorf, Medizinische Fakultät, Klinik für Kardiologie, Pneumologie und Angiologie, Düsseldorf
2   Florence-Nightingale Krankenhaus Düsseldorf, Klinik für Pneumologie, Kardiologie und Internistische Intensivmedizin, Düsseldorf
,
S. Steiner
3   St. Vincenz Krankenhaus, Klinik Kardiologie, Pneumologie und Internistische Intensivmedizin, Limburg/Lahn
› Author Affiliations
Subject Editor: G. Nilius, K. Rasche
Further Information

Publication History

Publication Date:
28 July 2017 (online)

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Zusammenfassung

Schlafbezogene Atmungsstörungen (SBAS) als häufige und relevante Komorbidität erfordern sowohl im perioperativen Management als auch in der intensivmedizinischen Behandlung kritisch kranker Patienten besondere Berücksichtigung. Patienten mit SBAS benötigen aufgrund eines erhöhten perioperativen Risikos für kardiale, pneumologische und neurologische Komplikationen eine maßgeschneiderte perioperative Überwachung und Therapie, wobei die aktuellen Empfehlungen primär Patienten mit einer obstruktiven Schlafapnoe betrachten. Die intensivmedizinische Behandlung von kritisch kranken Patienten mit SBAS erfordert ein aufmerksames Management während der Beatmung, in der Weaning- und in der Postextubationsphase, um das Risiko einer prolongierten Beatmung oder eines Weaningversagens zu reduzieren.

Abstract

There is a high prevalence of sleep related breathing disorders in critical ill patients and in perioperative settings. Nevertheless, less is known about their impact on clinical course and therapeutic strategies in this context. Intensive care physicians should be aware of difficult airway, weaning- and post-extubation failure and negative impact of SRBD on hemodynamics. Sedatives and analgetics might worsen SRBD and their use should be restricted as far as possible, furthermore the use of NIV might be beneficial. However, there is a lack of evidence with regard to this strategies.

 

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