Der schwierig zu weanende Patient

Kernaussagen

• Das frühzeitige Erkennen einer akuten respiratorischen Insuffizienz sowie die Behandlung der Ursache sind essenziell, weil sich daraus unterschiedliche Folgerungen für die Beatmungstherapie und die Beatmungsentwöhnung ergeben.

• Die maschinelle Beatmung ist einer der wesentlichen Grundpfeiler der Intensivmedizin und dient der Behandlung der akuten respiratorischen Insuffizienz. Gerade die invasive maschinelle Beatmung ist mit substanziellen Risiken verbunden und sollte so rasch wie möglich wieder beendet werden.

• So bald als möglich muss man die Spontanatmungsaktivität des Patienten überprüfen.

• Weaning-Protokolle, aber vor allem gebündelte Strategien können helfen, den Prozess des Weanings zu lenken. Hierzu zählen auch die patientengesteuerte Beatmungsunterstützung, eine frühzeitige Tracheotomie und die nicht invasive Beatmung.

• Das prolongierte Weaning ist vor allem von der ausgeprägten muskulären Schwäche geprägt. Die muskuläre Rehabilitation ist aufwendig und erfordert systematische physiotherapeutische und logopädische Maßnahmen.

• Substanzielle Begleiterkrankungen wie die Herzinsuffizienz muss man differenzialdiagnostisch berücksichtigen.

• Die Indikation zur außerklinischen Beatmung sollte nur ein spezialisiertes Weaning-Zentrum stellen. Die Überleitung ist komplex und erfordert ein erfahrenes Behandlungsteam.

• Literatur

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