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Anästhesiol Intensivmed Notfallmed Schmerzther 2013; 48(10): 622-625
DOI: 10.1055/s-0033-1358626
Fachwissen
Intensivmedizin Topthema: Respiratorentwöhnung
© Georg Thieme Verlag Stuttgart · New York

Respiratorentwöhnung – Definition und klinischer Kontext aus Sicht der Pädiatrie

Current concepts of weaning children from invasive ventilation
Hans Fuchs
,
Thomas Nicolai
,
Manuel B Schmid
,
Marcus Krüger
Further Information

Publication History

Publication Date:
05 November 2013 (online)

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Zusammenfassung

Trotz der Wichtigkeit ist standardisiertes Weaning in der Pädiatrie ein bisher zu wenig beachteter Aspekt pädiatrischer klinischer Intensivtherapie und Forschung. Erste mäßige Evidenz aus einzelnen Studien für Verbesserung des Weaningerfolgs besteht für die tägliche Evaluation der Weaningfähigkeit, für die Verwendung von Sedierungsprotokollen, für das tägliche Unterbrechen von Sedierung nach Abschluss der Akutphase, für den Einsatz von nicht invasiver Beatmung bei zu erwartendem schwierigenWeaning sowie für die Gabe von Steroiden zur Prophylaxe von Postextubationsstridor bei Risikopatienten. Aufgrund der in der pädiatrischen Intensivmedizin sehr unterschiedlichen Patientengruppen ist jedoch auch in diesen Punkten eine Generalisierung der Daten erschwert.

Timely weaning from invasive ventilation is of major importance to limit time of invasive ventilation and improve outcomes. However, in pediatrics only limited knowledge on the optimal weaning approach is available. In this review evidence from recent trials on weaning in pediatrics is summarized. Standardized daily evaluation of weaning readiness, daily interruption of sedation, use of pediatric sedation protocols, application of noninvasive ventilation and prophylactic treatment with steroids of patients with high risk for postextubation upper airway obstruction have been shown to decrease duration of invasive ventilation or to decrease the risk of extubation failure. However, due to the heterogeneous patient population in pediatric intensive care units, an individual approach might be necessary for certain subgroups of pediatric patients.

Kernaussagen

  • Die standardisierte tägliche Evaluation von Beatmungs- und Vitalparametern mit dem Ziel Weaningfähigkeit festzulegen, verkürzt Beatmungszeiten.

  • Der Entwöhnmodus hatte bei Kindern keinen Einfluss auf die Dauer der Beatmung.

  • Sedierungsprotokolle sollten auch bei Kindern angewendet werden, um die Tiefe der Sedierung zu steuern.

  • Tägliches Unterbrechen der Sedierung jenseits der Akutphase einer Beatmungstherapie reduzierte die Beatmungsdauer von Kindern.

  • Bei der Anwendung von Propofol müssen aufgrund eines bei Kindern häufigeren Auftretens des Propofolinfusionssyndroms die Anwendungsbeschränkungen und die max. Dosisempfehlungen dringend beachtet werden.

  • Die frühzeitige Tracheotomie ist bei Kindern aus verschiedenen Gründen nicht üblich.

  • Die Anwendung eines Spontanatemversuchs vor Extubation ist im Kindesalter umstritten.

  • Bei hohem Risiko für Postextubationsstridor ist eine prophylaktische Steroidgabe 6–24 h vor Extubation sinnvoll.

  • Nicht invasive Beatmung nach Extubation ist auch bei Kindern machbar und sinnvoll, um das Risiko des Extubationsversagens zu vermindern.

Schlüsselwörter:

Exubation - Kinder - Weaning - Entwöhnung - Stridor - Sedierung - Beatmung - Pädiatrie

Key words:

Extubation - Child - Weaning - Stridor - Sedation - Ventilation - Pediatrics

Ergänzendes Material

 

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