Skip to main content
main-content

2018 | OriginalPaper | Buchkapitel

9. Atemgaskonditionierung, endotracheale Absaugung, physikalische Therapie

verfasst von: Reinhard Larsen, Thomas Ziegenfuß

Erschienen in: Beatmung

Verlag: Springer Berlin Heidelberg

Zusammenfassung

Die Lungenpflege gehört zu den wichtigsten pflegerischen Maßnahmen beim Intensivpatienten, v. a. während der maschinellen Atemunterstützung. Keine andere pflegerische Maßnahme hat so viel Einfluss auf die Funktion eines Vitalorgans wie die Lungenpflege. Die Notwendigkeit einer intensiven Lungenpflege ergibt sich aus den Besonderheiten der endotrachealen Intubation und der maschinellen Beatmung: Der Tubus schaltet den oberen Respirationstrakt funktionell aus; daher werden die Atemgase nicht mehr ausreichend erwärmt, angefeuchtet und gefiltert. Der Hustenmechanismus ist durch den Tubus sowie die zugeführten Analgetika und Sedativa meist erheblich beeinträchtigt oder bei Verwendung von Muskelrelaxanzien vollständig ausgeschaltet. Die Sekretproduktion ist durch die maschinelle Beatmung und den Reiz des Endotrachealtubus gesteigert, die mukoziliäre Clearance vermindert.
Literatur
Zurück zum Zitat Bloomfield R, Noble DW, Sudlow A (2015) Prone position for acute respiratory failure in adults. Cochrane Database Syst Rev (11): CD008095 Bloomfield R, Noble DW, Sudlow A (2015) Prone position for acute respiratory failure in adults. Cochrane Database Syst Rev (11): CD008095
Zurück zum Zitat Boyer A, Vargas F, Hilbert G, Gruson D, Mousset-Hovaere M, Castaing Y, Dreyfuss D, Ricard JD (2010) Small dead space heat and moisture exchangers do not impede gas exchange during noninvasive ventilation: a comparison with a heated humidifier. Intensive Care Med 36(8): 1348–1354 Boyer A, Vargas F, Hilbert G, Gruson D, Mousset-Hovaere M, Castaing Y, Dreyfuss D, Ricard JD (2010) Small dead space heat and moisture exchangers do not impede gas exchange during noninvasive ventilation: a comparison with a heated humidifier. Intensive Care Med 36(8): 1348–1354
Zurück zum Zitat Doyle A, Mariyaselvam M, Wijewardena G, English N, Gent E, Young P (2015) The simultaneous use of a heat and moisture exchanger and a heated humidifier causes critical airway occlusion in less than 24 hours. J Crit Care 30(4): 863.e1–863.e3. Doyle A, Mariyaselvam M, Wijewardena G, English N, Gent E, Young P (2015) The simultaneous use of a heat and moisture exchanger and a heated humidifier causes critical airway occlusion in less than 24 hours. J Crit Care 30(4): 863.e1–863.e3.
Zurück zum Zitat Hanekom S, Gosselink R, Dean E, van Aswegen H, Roos R, Ambrosino N, Louw Q (2011) The development of a clinical management algorithm for early physical activity and mobilization of critically ill patients: synthesis of evidence and expert opinion and its translation intro practice. Clin Rehabil 25(9): 771–787 Hanekom S, Gosselink R, Dean E, van Aswegen H, Roos R, Ambrosino N, Louw Q (2011) The development of a clinical management algorithm for early physical activity and mobilization of critically ill patients: synthesis of evidence and expert opinion and its translation intro practice. Clin Rehabil 25(9): 771–787
Zurück zum Zitat Hashem MD, Parker AM, Needham DM (2016) Early mobilization and rehabilitation of patients who are critically Ill. Chest 150(3): 722–731 Hashem MD, Parker AM, Needham DM (2016) Early mobilization and rehabilitation of patients who are critically Ill. Chest 150(3): 722–731
Zurück zum Zitat Hewitt N, Bucknall T, Faraone NM (2016) Lateral positioning for critically ill adult patients. Cochrane Database Syst Rev (5): CD007205 Hewitt N, Bucknall T, Faraone NM (2016) Lateral positioning for critically ill adult patients. Cochrane Database Syst Rev (5): CD007205
Zurück zum Zitat Jolley SE, Moss M, Needham DM, Caldwell E, Morris PE, et al. (2017) Point prevalence study of mobilization practices for acute respiratory failure patients in the United States. Crit Care Med 45(2): 205–215 Jolley SE, Moss M, Needham DM, Caldwell E, Morris PE, et al. (2017) Point prevalence study of mobilization practices for acute respiratory failure patients in the United States. Crit Care Med 45(2): 205–215
Zurück zum Zitat Jongerden IP, Buiting AG, Leverstein-van Hall MA, Speelberg B, Zeidler S, Kesecioglu J, Bonten MJ (2011) Effect of open and closed endotracheal suctioning on cross-transmission with Gram-negative bacteria: a prospective crossover study. Crit Care Med 39(6): 1313–1321 Jongerden IP, Buiting AG, Leverstein-van Hall MA, Speelberg B, Zeidler S, Kesecioglu J, Bonten MJ (2011) Effect of open and closed endotracheal suctioning on cross-transmission with Gram-negative bacteria: a prospective crossover study. Crit Care Med 39(6): 1313–1321
Zurück zum Zitat Jongerden IP, Kesecioglu J, Speelberg B, Buiting AG, Leverstein-van Hall MA, Bonten MJ (2012) Changes in heart rate, mean arterial pressure, and oxygen saturation after open and closed endotracheal suctioning: a prospective observational study. J Crit Care 27(6): 647–654 Jongerden IP, Kesecioglu J, Speelberg B, Buiting AG, Leverstein-van Hall MA, Bonten MJ (2012) Changes in heart rate, mean arterial pressure, and oxygen saturation after open and closed endotracheal suctioning: a prospective observational study. J Crit Care 27(6): 647–654
Zurück zum Zitat Kuriyama A, Umakoshi N, Fujinaga J, Takada T (2015) Impact of closed versus open tracheal suctioning systems for mechanically ventilated adults: a systematic review and meta-analysis. Intensive Care Med 41(3): 402–411 Kuriyama A, Umakoshi N, Fujinaga J, Takada T (2015) Impact of closed versus open tracheal suctioning systems for mechanically ventilated adults: a systematic review and meta-analysis. Intensive Care Med 41(3): 402–411
Zurück zum Zitat Lai CC, Chou W, Chan KS, Cheng KC, Yuan KS, Chao CM, Chen CM (2017) Early mobilization reduces duration of mechanical ventilation and intensive care unit stay in patients with acute respiratory failure. Arch Phys Med Rehabil 98(5): 931–939 Lai CC, Chou W, Chan KS, Cheng KC, Yuan KS, Chao CM, Chen CM (2017) Early mobilization reduces duration of mechanical ventilation and intensive care unit stay in patients with acute respiratory failure. Arch Phys Med Rehabil 98(5): 931–939
Zurück zum Zitat Menegueti MG, Auxiliadora-Martins M, Nunes AA (2014) Effectiveness of heat and moisture exchangers in preventing ventilator-associated pneumonia in critically ill patients: a meta-analysis. BMC Anesthesiol 14: 115 Menegueti MG, Auxiliadora-Martins M, Nunes AA (2014) Effectiveness of heat and moisture exchangers in preventing ventilator-associated pneumonia in critically ill patients: a meta-analysis. BMC Anesthesiol 14: 115
Zurück zum Zitat Robert Koch-Institut (RKI) (2013) Prävention der nosokomialen beatmungsassoziierten Pneumonie. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 56: 1578–1590 Robert Koch-Institut (RKI) (2013) Prävention der nosokomialen beatmungsassoziierten Pneumonie. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 56: 1578–1590
Zurück zum Zitat Schweickert WD, Kress JP (2012) Implementing early mobilization interventions in mechanically ventilated patients in the ICU. Chest 140(6): 1612–1617 Schweickert WD, Kress JP (2012) Implementing early mobilization interventions in mechanically ventilated patients in the ICU. Chest 140(6): 1612–1617
Zurück zum Zitat Wang L, Li X, Yang Z, Tang X, Yuan Q, Deng L, Sun X (2016) Semi-recumbent position versus supine position for the prevention of ventilator-associated pneumonia in adults requiring mechanical ventilation. Cochrane Database Syst Rev (1): CD009946 Wang L, Li X, Yang Z, Tang X, Yuan Q, Deng L, Sun X (2016) Semi-recumbent position versus supine position for the prevention of ventilator-associated pneumonia in adults requiring mechanical ventilation. Cochrane Database Syst Rev (1): CD009946
Metadaten
Titel
Atemgaskonditionierung, endotracheale Absaugung, physikalische Therapie
verfasst von
Reinhard Larsen
Thomas Ziegenfuß
Copyright-Jahr
2018
Verlag
Springer Berlin Heidelberg
DOI
https://doi.org/10.1007/978-3-662-54853-0_9

Neu im Fachgebiet AINS

Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update AINS und bleiben Sie gut informiert – ganz bequem per eMail.