Beatmung bei chronisch ventilatorischer Insuffizienz

Abstract

Mechanical ventilation has become an important treatment option in chronic ventilatory failure. There are different diseases which lead to ventilatory failure and to home mechanical ventilation (HMV). A primary loss of in- and expiratory muscle strength is the reason for respiratory deterioration in neuromuscular disease. In most of these diseases ventilatory failure develops because of the progressive character of muscular damage. Initially, ventilatory failure can be found during night-time. In the case of hypercapnia at daytime, life expectancy is strongly reduced, especially in amyotrophic lateral sclerosis and Duchenne muscular dystrophy. HMV leads to a prolongation of life and to an increase in quality of life, if bulbar involvement is not severe. Impressive clinical improvements under HMV have been found in restrictive disorders of the rib cage like kyphoscoliosis or posttuberculosis sequelae, with an increase of quality of life, walking distance and a decrease in pulmonary hypertension. Only few data are published about long-term results of HMV in Obesity Hypoventilation. In terms of retrospective analyses of clinical data HMV seems to improve survival in this population. Some patients only need CPAP treatment, but most patients have to be treated with ventilatory support. The application of HMV in patients with chronic ventilatory failure due to chronic obstructive pulmonary disease (COPD) is growing, but there are controversial results in randomised clinical trials. Analysis of these data suggest better results of HMV in patients with severe hypercapnia, with the application of higher effective ventilatory pressure and a ventilator mode with a significant reduction in the work of breathing. Under such conditions HMV leads to a reduction of hypercapnia, an improvement in sleep quality, walking distance and quality of life, but until now there is no evidence in reduction of mortality in COPD.

Palliative Care Concepts in Respiratory Disease

“…These features help patients to keep their self-determination. Intermittent noninvasive mechanical ventilation in COPD may not prolong life but can improve quality of life measured with different tools [8]. The indications for noninvasive ventilation in chronic respiratory failure due to COPD are outlined in table 1[9].…”

Untitled

“…Kompensation der insuffizienten Atemmuskulatur. Sie gilt heute als ein etabliertes Therapieverfahren bei CVI und wird auch bei der ALS eingesetzt [5,6]. nachts) mittels BGA-Gerät "Typ 840" der Fa.…”

Physiologische Atmungsparameter und der Effekt der nicht invasiven Beatmung (NIV) bei Patienten mit amyotropher Lateralsklerose (ALS)

“…Kompensation der insuffizienten Atemmuskulatur. Sie gilt heute als ein etabliertes Therapieverfahren bei CVI und wird auch bei der ALS eingesetzt [5,6]. ; " Blutgasanalyse (mehrere tagsüber und mindestens eine nachts) mittels BGA-Gerät "Typ 840" der Fa.…”