Invasive Beatmung bei Mukoviszidose (Fallbericht)

Summary

Artificial mechanical ventilation, a therapeutic standard in patients with acute respiratory failure, effectively improves gas exchange. New strategies and new ventilators improve outcome and reduce complications. Should mechanical ventilation be considered an option in treating chronic respiratory failure, especially in patients with cystic fibrosis (CF)?

We review our experiences in artificial mechanical ventilation in a 20-year-old woman with CF with respiratory failure requiring mechanical ventilation. Mechanical ventilation improved arterial hypoxemia but failed to correct hypercapnia. Peak inspiratory pressure, positive end-expiratory pressure, oxygen saturation, and blood gases under different modes of artificial ventilation are demonstrated and discussed.

Normalization of p_aCO₂ was only achieved by aggressive artificial ventilation with high peak inspiratory pressures. Weaning maneuvers and other manipulations such as sucking of secretions by bronchoscope or bronchoalveolar lavage via endotracheal tube resulted in prolonged episodes of arterial hypoxemia and hypercapnia. Artificial ventilation improved oxygenation rapidly with quite moderate inspiratory pressures in our patient. In contrast, normalization of hypercapnia was seen only under aggressive modes of ventilation preventing sucessful weaning. After 2 weeks our patient died due to respiratory insufficiency.

Therefore, despite blood gases ethical considerations should also be considered in the treatment of chronic respiratory failure by mechanical ventilation in adult patients with CF.