Nichtinvasive Beatmung als Therapie der akuten respiratorischen Insuffizienz[1]

Inhalt Seite 1 Einleitung 450 1.1 Ziel dieser Leitlinie 450 1.2 Mitglieder des Leitlinienkomitees 450 1.3 Methodik 451 1.4 Beteiligung der Industrie 451 1.5 Finanzierung der Leitlinie 452 1.6 Gültigkeit der Leitlinie 452 1.7 Tabellen 452 2 Allgemeines zur nichtinvasiven Beatmung bei akuter respiratorischer Insuffizienz 452 2.1 Empfehlungen 452 2.2 Pathophysiologischer Hintergrund 452 2.3 Vergleich von invasiver Beatmung und NIV 452 2.4 Häufigkeit der Anwendung von NIV und Erfahrung mit NIV 453 2.5 Kontraindikationen der NIV 453 2.6 Kosten 453 2.7 Tabellen 454 3 Hyperkapnische ARI 454 3.1 Empfehlungen 454 3.2 Pathogenese und Klinik des hyperkapnischen Atmungsversagens 454 3.3 Akute hyperkapnische Exazerbation der COPD (AECOPD) 455 3.3.1 Spezifische Wirkung der NIV bei AECOPD 455 3.3.2 Häufigkeit der Anwendung von NIV bei AECOPD 455 3.3.3 NIV bei leicht- bis mittelgradiger ARI infolge AECOPD 455 3.3.4 Erfolg und Versagen der NIV 455 3.3.5 Prädiktoren des NIV-Versagens 455 3.3.6 Leichtgradige Form der AECOPD 456 3.3.7 NIV bei schwergradiger ARI infolge AECOPD alternativ zur invasiven Beatmung 456 3.3.8 Besondere Aspekte 456 3.4 Hyperkapnische ARI infolge anderer Indikationen 456 3.4.1 Asthma bronchiale 456 3.4.2 Akut auf chronisch ventilatorische Insuffizienz 456 3.5 Tabelle und Algorithmus 457 4 ARI bei kardialem Lungenödem 457 4.1 Empfehlungen 457 4.2 CPAP bzw. NIV beim akuten kardialen Lungenödem 457 4.3 Studienlage und Evidenz für CPAP bzw. NIV beim akuten kardialen Lungenödem 457 4.4 Bewertung der Studienlage 458 4.5 Algorithmus 458 5 Hypoxämische ARI, nicht kardial bedingt 458 5.1 Empfehlungen 458 5.2 Allgemeine Aspekte von CPAP bzw. NIV 458 5.2.1 Studienlage 458 5.2.2 Auswirkungen auf die Ventilation, Oxygenierung und Atemmechanik 459 5.2.3 Möglichkeiten und Grenzen von CPAP bzw. NIV bei Atelektasenbildung 459 5.3 Spezifische Indikationen für CPAP bzw. NIV 459 5.3.1 Immunsupprimierte Patienten, AIDS und Pneumocystis-Pneumonie 459 5.3.2 Ambulant erworbene Pneumonie 459 5.3.3 Trauma/Verbrennung 459 5.3.4 Lungenfibrose 460 5.3.5 Cystische Fibrose 460 5.3.6 ARDS 460 5.4 Studien zu gemischten Patientenkollektiven mit hypoxämischer ARI 461 5.5 Präoxygenierung 461 6 Schwierige Entwöhnung vom Respirator und Postextubationsphase 461 6.1 Empfehlungen 461 6.2 Einsatz der NIV im Entwöhnungsprozess 461 6.3 NIV bei schwieriger Entwöhnung 461 6.3.1 Hintergrund 461 6.3.2 Epidemiologie 461 6.3.3 Pathophysiologie und Therapiekonzept 461 6.3.4 Hyperkapnische ARI 462 6.3.5 Hypoxämische ARI 462 6.3.6 Kriterien zur „NIV-Fähigkeit” im Entwöhnungsprozess 462 6.4 NIV bei ARI in der Postextubationsphase 462 6.4.1 Hintergrund 462 6.4.2 Pathophysiologie und Therapiekonzept 462 6.4.3 Hyperkapnische ARI 463 6.4.4 Hypoxämische ARI 463 6.5 Tabellen 463 7 Perioperative und periinterventionelle Anwendung 463 7.1 Empfehlungen 463 7.2 Physiologische Grundlagen: OP-bedingte Veränderungen der Lungenfunktion 463 7.3 Präoperative Anwendung der NIV 464 7.4 Postoperative Anwendung der NIV 464 7.4.1 Mögliche Therapieansätze 464 7.4.2 Klinische Anwendungen 465 7.5 Periinterventionelle Anwendung der NIV 466 8 ARI bei Kindern und Jugendlichen 466 8.1 Empfehlungen 466 8.2 Studienlage 466 8.3 Spezifische Krankheitsbilder 466 8.3.1 Cystische Fibrose 466 8.3.2 Neuromuskuläre Erkrankungen 466 8.3.3 Immunsupprimierte Patienten 467 8.4 Spezifische Aspekte zu NIV bei Kindern 467 8.4.1 Akzeptanz 467 8.4.2 Interfaces 467 8.4.3 Monitoring und Einsatzort 467 8.5 Tabelle und Algorithmus 467 9 Palliativmedizin 468 9.1 Empfehlungen 468 9.2 Hintergrund 468 9.3 NIV als Palliativmaßnahme zur Linderung von Dyspnoe 468 9.4 NIV bei Vorliegen einer Do-Not-Intubate- oder Do-Not-Resuscitate-Verfügung 468 10 Technik und Anwendung der NIV 469 10.1 Empfehlungen 469 10.2 Beatmungsmodus 469 10.2.1 Beatmung im assistierten Modus mit Druckvorgabe 469 10.2.2 Beatmung mit Volumenvorgabe 470 10.2.3 Beatmung im kontrollierten Modus 470 10.2.4 Proportional Assist Ventilation (PAV) 470 10.2.5 CPAP 470 10.3 Beatmungsgeräte (Ventilatoren) 470 10.3.1 Unterschiede Intensiv-/Heimventilatoren 470 10.3.2 Eigenschaften NIV-tauglicher Beatmungssysteme 470 10.4 Beatmungszugang (Interface) 470 10.4.1 Masken 470 10.4.2 Beatmungshelm 471 10.5 Aspekte zur praktischen Durchführung der NIV 471 10.5.1 Einsatzort 471 10.5.2 Adaptationsphase 472 10.5.3 Beatmungsparameter 472 10.5.4 Sedierung 473 10.5.5 Monitoring 473 10.6 Tabellen 473 Anhang 473 Abkürzungen 473 Literaturrecherche: Suchstichwörter 474 Literaturverzeichnis 474

1 Leitlinienprojekt moderiert von der Arbeitsgemeinschaft Wissenschaftlich-Medizinischer Fachgesellschaften (AWMF)

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