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01.11.2008 | Leitlinien und Empfehlungen

Nichtinvasive Beatmung als Therapie der akuten respiratorischen Insuffizienz

Das Wichtigste der neuen S3-Leitlinie

verfasst von: Prof. Dr. B. Schönhofer, R. Kuhlen, P. Neumann, M. Westhoff, C. Berndt, H. Sitter

Erschienen in: Die Anaesthesiologie | Ausgabe 11/2008

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Zusammenfassung

Hintergrund

Der zunehmende Stellenwert der nichtinvasiven Beatmung (NIV) in der Therapie der akuten respiratorischen Insuffizienz (ARI) ist durch klinische Studien untermauert. Eine neue S3-Leitlinie macht das evidenzbasierte Wissen über Indikationen und Grenzen der NIV bei ARI in der Praxis verfügbar.

Methoden

An der Entwicklung der Leitlinie beteiligten sich 28 Experten aus 12 medizinischen Fachgesellschaften. Zirka 2900 Veröffentlichungen wurden systematisch analysiert. In 2 Konsensuskonferenzen wurden die Kernaussagen verabschiedet.

Ergebnisse

Bei hyperkapnischer ARI verkürzt NIV die Aufenthaltsdauer und verringert die Letalitätsrate auf der Intensivstation [Empfehlungsgrad A (A)]. Patienten mit kardialem Lungenödem sollten mit NIV (bzw. „continuous positive airway pressure“, CPAP) behandelt werden (A). Bei immunsupprimierten Patienten mit ARI senkt NIV die Letalitätsrate (A). In der Postextubationsphase und im „weaning“ bei hyperkapnischer ARI senkt NIV das Risiko der Reintubation (A). Patienten, die eine Intubation ablehnen, können mit NIV behandelt werden (B). In der Pädiatrie wird NIV bei verschiedenen Indikationen eingesetzt (C). Bei Patienten mit „acute respiratory distress syndrome“ (ARDS) ist NIV wegen der hohen Misserfolgsrate nicht generell zu empfehlen.

Fazit

Noch ist die NIV an die Akutmedizin nicht so fest verankert, wie es aufgrund der wissenschaftlichen Evidenz zu erwarten wäre. Diese Leitlinie soll dazu beitragen, die NIV als Therapie der ARI breiter zu etablieren.

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Titel: Nichtinvasive Beatmung als Therapie der akuten respiratorischen Insuffizienz
Das Wichtigste der neuen S3-Leitlinie
verfasst von: Prof. Dr. B. Schönhofer
R. Kuhlen
P. Neumann
M. Westhoff
C. Berndt
H. Sitter
Publikationsdatum: 01.11.2008
Verlag: Springer-Verlag
Erschienen in: Die Anaesthesiologie / Ausgabe 11/2008
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI: https://doi.org/10.1007/s00101-008-1449-0

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