Skip to main content

Beatmung, Atemregulation und Weaning, ARDS

  • Chapter
NeuroIntensiv
  • 1473 Accesses

Auszug

Die maschinelle Beatmung stellt einen wesentlichen Teil der intensivmedizinischen Maßnahmen dar, da insbesondere bei Patienten mit zerebralen Beeinträchtigungen fast regelhaft auch eine Störung der Atemfunktion vorliegt. Die Entwicklung moderner Intensivventilatoren begann mit den großen Polioepidemien in Europa in den 1950er Jahren. Inzwischen stehen hochkomplexe, computergesteuerte technische Geräte zur Verfügung, die zur Ausnutzung ihrer Potenziale vom Anwender grundlegende Kenntnisse der Atemphysiologie und spezifische Kenntnisse der Atemregulation erfordern. Die Vielfalt verfügbarer Verfahren und Beatmungsmodi macht es ausgesprochen schwierig, für jeden Patienten eine individuell angepasste Therapie durchzuführen. Genau das ist jedoch insofern wichtig, als die maschinelle Beatmung zwar eine lebensrettende Maßnahme darstellt, die Art der Durchführung aber aufgrund ihrer Invasivität mitbestimmend für das überleben ist.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. Dreyfuss D, Saumon G. Ventilator-induced lung injury: lessons from experimental studies. Am J Respir Crit Care Med 1998;157:294–323.

    PubMed  CAS  Google Scholar 

  2. Slutsky AS, Tremblay LN. Multiple system organ failure. Is mechanical ventilation a contributing factor? Am J Respir Crit Care Med 1998;157:1721–5.

    PubMed  CAS  Google Scholar 

  3. Esteban A, Anzueto A, Frutos F, Alia I, Brochard L, Stewart TE, Benito S, Epstein SK, Apezteguia C, Nightingale P, Arroliga AC, Tobin MJ. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA 2002;287:345–55.

    Article  PubMed  Google Scholar 

  4. Hedenstierna G, Tokics L, Lundquist H, Andersson T, Strandberg A, Brismar B. Phrenic nerve stimulation during halothane anesthesia. Effects of atelectasis. Anesthesiology 1994;80:751–60.

    Article  PubMed  CAS  Google Scholar 

  5. Hormann C, Baum M, Putensen C, Kleinsasser A, Benzer H. Effects of spontaneous breathing with BIPAP on pulmonary gas exchange in patients with ARDS. Acta Anaesthesiol Scand Suppl 1997;111:152–5.

    PubMed  CAS  Google Scholar 

  6. Steinhoff H, Falke KJ, Schwarzhoff W. Enhanced renal function associated with intermittent mandatory ventilation in acute respiratory failure. Intensive Care Med 1982;8:69–74.

    Article  PubMed  CAS  Google Scholar 

  7. Putensen C, Zech S, Wrigge H, Zinserling J, Stuber F, von Spiegel T, Mutz N. Long-term effects of spontaneous breathing during ventilatory support in patients with acute lung injury. Am J Respir Crit Care Med 2001;164:43–9.

    PubMed  CAS  Google Scholar 

  8. The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000;342:1301–8.

    Article  Google Scholar 

  9. Eichacker PQ, Gerstenberger EP, Banks SM, Cui X, Natanson C. Metaanalysis of acute lung injury and acute respiratory distress syndrome trials testing low tidal volumes. Am J Respir Crit Care Med 2002;166:1510–4.

    Article  PubMed  Google Scholar 

  10. Brochard L, Rauss A, Benito S, Conti G, Mancebo J, Rekik N, Gasparetto A, Lemaire F. Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med 1994;150:896–903.

    PubMed  CAS  Google Scholar 

  11. Kleinman BS, Frey K, VanDrunen M, Sheikh T, DiPinto D, Mason R, Smith T. Motion of the diaphragm in patients with chronic obstructive pulmonary disease while spontaneously breathing versus during positive pressure breathing after anesthesia and neuromuscular blockade. Anesthesiology 2002;97:298–305.

    Article  PubMed  Google Scholar 

  12. Meade M, Guyatt G, Cook D, Griffith L, Sinuff T, Kergl C, Mancebo J, Esteban A, Epstein S. Predicting success in weaning from mechanical ventilation. Chest 2001;120:400S–24S.

    Article  PubMed  CAS  Google Scholar 

  13. Sauaia A, Moore FA, Moore EE, Norris JM, Lezotte DC, Hamman RF. Multiple organ failure can be predicted as early as 12 hours after injury. J Trauma 1998;45:291–301.

    Article  PubMed  CAS  Google Scholar 

  14. Hickling KG, Walsh J, Henderson S, Jackson R. Low mortality rate in adult respiratory distress syndrome using low-volume, pressure-limited ventilation with permissive hypercapnia: a prospective study. Crit Care Med 1994;22:1568–78.

    Article  PubMed  CAS  Google Scholar 

  15. Dembinski R, Max M, Bensberg R, Rossaint R, Kuhlen R. Pressure Support Compared with Controlled Mechanical Ventilation in Experimental Lung Injury. Anesth Analg 2002;94:1570–6.

    Article  PubMed  Google Scholar 

  16. International Consensus Conferences in Intensive Care Medicine: noninvasive positive pressure ventilation in acute Respiratory failure. Am J Respir Crit Care Med 2001;163:283–91.

    Google Scholar 

  17. Burchardi H, Kuhlen R, Schonhofer B, Muller E, Criee CP, Welte T. [Noninvasive ventilation. Consensus statement on indications, possibilities and use in acute respiratory insufficiency]. Anaesthesist 2002;51:33–41.

    Article  PubMed  CAS  Google Scholar 

  18. Antonelli M, Pennisi MA, Pelosi P, Gregoretti C, Squadrone V, Rocco M, Cecchini L, Chiumello D, Severgnini P, Proietti R, Navalesi P, Conti G. Noninvasive positive pressure ventilation using a helmet in patients with acute exacerbation of chronic obstructive pulmonary disease: a feasibility study. Anesthesiology 2004;100:16–24.

    Article  PubMed  Google Scholar 

  19. Esteban A, Frutos-Vivar F, Ferguson ND, Arabi Y, Apezteguia C, Gonzalez M, Epstein SK, Hill NS, Nava S, Soares MA, D’Empaire G, Alia I, Anzueto A. Noninvasive positive-pressure ventilation for respiratory failure after extubation. N Engl J Med 2004;350:2452–60.

    Article  PubMed  CAS  Google Scholar 

  20. Esteban A, Alia I, Tobin MJ, Gil A, Gordo F, Vallverdu I, Blanch L, Bonet A, Vazquez A, de Pablo R, Torres A, de la Cal MA, Macias S. Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation. Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med 1999;159:512–8.

    PubMed  CAS  Google Scholar 

  21. Ely EW, Baker AM, Dunagan DP, Burke HL, Smith AC, Kelly PT, Johnson MM, Browder RW, Bowton DL, Haponik EF. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 1996;335:1864–9.

    Article  PubMed  CAS  Google Scholar 

  22. Boulain T. Unplanned extubations in the adult intensive care unit: a prospective multicenter study. Association des Reanimateurs du Centre-Ouest. Am J Respir Crit Care Med 1998;157:1131–7.

    PubMed  CAS  Google Scholar 

  23. Saura P, Blanch L, Mestre J, Valles J, Artigas A, Fernandez R. Clinical consequences of the implementation of a weaning protocol. Intensive Care Med 1996;22:1052–6.

    Article  PubMed  CAS  Google Scholar 

  24. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke KJ, Hudson L, Lamy M, LeGall JR, Morris A, Spragg R. Report of the American-European consensus conference on ARDS: definitions, mechanisms, relevant outcomes and clinical trial coordination. The Consensus Committee. Intensive Care Med 1994;20:225–32.

    Article  PubMed  CAS  Google Scholar 

  25. Gattinoni L, Caironi P, Pelosi P, Goodman LR. What has computed tomography taught us about the acute respiratory distress syndrome? Am J Respir Crit Care Med 2001;164:1701–11.

    PubMed  CAS  Google Scholar 

  26. Ware LB, Matthay MA. The acute respiratory distress syndrome. N Engl J Med 2000;342:1334–49.

    Article  PubMed  CAS  Google Scholar 

  27. Kopp R, Kuhlen R, Max M, Rossaint R. Evidence-based medicine in the therapy of the acute respiratory distress syndrome. Intensive Care Med 2002;28:244–55.

    Article  PubMed  Google Scholar 

  28. Bodi M, Ardanuy C, Olona M, Castander D, Diaz E, Rello J. Therapy of ventilator-associated pneumonia: the Tarragona strategy. Clin Microbiol Infect 2001;7:32–3.

    Article  PubMed  CAS  Google Scholar 

  29. Brower RG, Lanken PN, MacIntyre N, Matthay MA, Morris A, Ancukiewicz M, Schoenfeld D, Thompson BT. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med 2004;351:327–36.

    Article  PubMed  Google Scholar 

  30. Kuhlen R, Putensen C. Maintaining spontaneous breathing efforts during mechanical ventilatory support. Intensive Care Med 1999;25:1203–5.

    Article  PubMed  CAS  Google Scholar 

  31. Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, Connors AF, Jr., Hite RD, Harabin AL. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 2006;354:2564–75.

    Article  PubMed  CAS  Google Scholar 

  32. Metnitz PG, Krenn CG, Steltzer H, Lang T, Ploder J, Lenz K, Le Gall JR, Druml W. Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Crit Care Med 2002;30:2051–8.

    Article  PubMed  Google Scholar 

  33. Finfer S, Norton R, Bellomo R, Boyce N, French J, Myburgh J. The SAFE study: saline vs. albumin for fluid resuscitation in the critically ill. Vox Sang 2004;87Suppl 2:123–31.

    Article  PubMed  Google Scholar 

  34. Alderson P, Bunn F, Lefebvre C, Li WP, Li L, Roberts I, Schierhout G. Human albumin solution for resuscitation and volume expansion in critically ill patients. Cochrane Database Syst Rev 2004;CD001208.

    Google Scholar 

  35. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345:1368–77.

    Article  PubMed  CAS  Google Scholar 

  36. Gattinoni L, Tognoni G, Pesenti A, Taccone P, Mascheroni D, Labarta V, Malacrida R, Di Giulio P, Fumagalli R, Pelosi P, Brazzi L, Latini R. Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med 2001;345:568–73.

    Article  PubMed  CAS  Google Scholar 

  37. L’her E, Renault A, Oger E, Robaux MA, Boles JM. A prospective survey of early 12-h prone positioning effects in patients with the acute respiratory distress syndrome. Intensive Care Med 2002;28:570–5.

    Article  Google Scholar 

  38. Rossaint R, Falke KJ, Lopez F, Slama K, Pison U, Zapol WM. Inhaled nitric oxide for the adult respiratory distress syndrome. N Engl J Med 1993;328:399–405.

    Article  PubMed  CAS  Google Scholar 

  39. Kopp R, Henzler D, Dembinski R, Kuhlen R. [Extracorporeal membrane oxygenation by acute respiratory distress syndrome]. Anaesthesist 2004;53:168–74.

    Article  PubMed  CAS  Google Scholar 

  40. Rossaint R, Slama K, Lewandowski K, Streich R, Henin P, Hopfe T, Barth H, Nienhaus M, Weidemann H, Lemmens P,. Extracorporeal lung assist with heparin-coated systems. Int J Artif Organs 1992;15:29–34.

    PubMed  CAS  Google Scholar 

  41. Bein T, Weber F, Philipp A, Prasser C, Pfeifer M, Schmid FX, Butz B, Birnbaum D, Taeger K, Schlitt HJ. A new pumpless extracorporeal interventional lung assist in critical hypoxemia/hypercapnia. Crit Care Med 2006;34:1372–7.

    Article  PubMed  Google Scholar 

  42. Henzler D, Karmann S. Respiratorisches System. In: Rossaint R, Werner C, Zwissler B, eds. Die Anästhesiologie. Berlin, Heidelberg, New York: Springer, 2004.

    Google Scholar 

  43. Esteban A, Alia I. Clinical management of weaning from mechanical ventilation. Intensive Care Med 1998;24:999–1008.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2008 Springer Medizin Verlag Heidelberg

About this chapter

Cite this chapter

Henzler, D., Rossaint, R. (2008). Beatmung, Atemregulation und Weaning, ARDS. In: Schwab, S., Schellinger, P., Werner, C., Unterberg, A., Hacke, W. (eds) NeuroIntensiv. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-68317-9_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-540-68317-9_11

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-23051-9

  • Online ISBN: 978-3-540-68317-9

  • eBook Packages: Medicine (German Language)

Publish with us

Policies and ethics