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Nichtinvasive Beatmung zur Therapie der akuten respiratorischen Insuffizienz

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Die Intensivmedizin

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Zusammenfassung

Das respiratorische System besteht aus 2 weitgehend unabhängig voneinander arbeitenden Anteilen: dem Lungenparenchym für den Gasaustausch und der Atempumpe für die Ventilation. Schwerwiegende Erkrankungen führen zu unterschiedlichen Formen der akuten respiratorischen Insuffizienz (ARI) je nachdem, welcher Anteil betroffen ist. Bei einer Affektion des Lungenparenchyms kommt es zur hypoxämischen ARI; die Störung der Atempumpe führt zur hyperkapnischen ARI. Durch eine maschinelle Beatmung kann insbesondere die Ventilation augmentiert werden, was die Atemmuskulatur entlastet und ebenfalls den Gasaustausch verbessern kann. Neben der invasiven mechanischen Beatmung nimmt in der Therapie der ARI zunehmend nicht-invasive Beatmung (NIV) in Form einer über Masken oder Helm applizierten Positivdruckbeatmung, einen großen Stellenwert ein, da sich durch Einsatz der NIV häufig die mit invasiver Beatmung assoziierten Komplikationen vermeiden lassen.

Wenn möglich, sollte die NIV bei Erkrankungen, die zur hyperkapnischen ARI führen, angewendet werden, da hierdurch die Intubations- und Mortalitätsrate deutlich gesenkt werden kann (besonders für pH Werte zwischen 7,2–7,35).

Der Stellenwert der NIV bei hypoxämischer ARI ist deutlich geringer. Für das kardial bedingte Lungenödem ist der Effekt von „continuous positive airway pressure“ (CPAP) bzw. NIV in Kombination mit der medikamentösen Standardtherapie belegt. Hingegen kann die NIV bei der nicht kardialen hypoxämischen ARI nicht grundsätzlich als Therapie empfohlen werde. In der Behandlungsstrategie der Covid-19-induzierten hypoxämischen ARI ist NIV ein fester Bestandteil.

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  1. Klinik für Innere Medizin, Pneumologie und Intensivmedizin; Evangelisches Klinikum Bethel, Universitätsklinikum Ostwestphalen Lippe (OWL) der Universität Bielefeld, Bielefeld, Deutschland

    Bernd Schönhofer

  2. Fakultät für Gesundheit/Department für Humanmedizin, Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Universität Witten/Herdecke, Köln, Deutschland

    Sarah Bettina Schwarz

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  1. Bernd Schönhofer
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Editors and Affiliations

  1. Klinik für Anästhesiologie, RWTH Aachen Universitätsklinikum Aachen, Aachen, Deutschland

    Gernot Marx

  2. Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lübeck, Deutschland

    Elke Muhl

  3. Dir. der Klinik fuer Anaesthesie Intensivmed. und Schmerzther., Frankfurt, Hessen, Deutschland

    Kai Zacharowski

  4. Medizinische Klinik 1, Universitätsklinikum Frankfurt, Frankfurt am Main, Hessen, Deutschland

    Stefan Zeuzem

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Schönhofer, B., Schwarz, S.B. (2023). Nichtinvasive Beatmung zur Therapie der akuten respiratorischen Insuffizienz. In: Marx, G., Muhl, E., Zacharowski, K., Zeuzem, S. (eds) Die Intensivmedizin. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54675-4_31-2

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    Nichtinvasive Beatmung zur Therapie der akuten respiratorischen Insuffizienz
    Published:
    04 April 2023

    DOI: https://doi.org/10.1007/978-3-642-54675-4_31-2

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    Nichtinvasive Beatmung zur Therapie der akuten respiratorischen Insuffizienz
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    18 June 2015

    DOI: https://doi.org/10.1007/978-3-642-54675-4_31-1

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