Nicht-invasive Beatmung als Therapie der akuten respiratorischen Insuffizienz

Abstract

The non-invasive ventilation (NIV) is widespread in the clinical medicine and has attained meanwhile a high value in the clinical daily routine. The application of NIV reduces the length of ICU stay and hospitalization as well as mortality of patients with hypercapnic acute respiratory failure. Patients with acute respiratory failure in context of a cardiopulmonary edema should be treated in addition to necessary cardiological interventions with continuous positive airway pressure (CPAP) or NIV. In case of other forms of acute hypoxaemic respiratory failure it is recommended the application of NIV to be limited to mild forms of ARDS as the application of NIV in severe forms of ARDS is associated with higher rates of treatment failure and mortality. In weaning process from invasive ventilation the NIV reduces the risk of reintubation essentially in hypercapnic patients. A delayed intubation of patients with NIV failure leads to an increase of mortality and should therefore be avoided. With appropriate monitoring in intensive care NIV can also be successfully applied in pediatric patients with acute respiratory insufficiency. Furthermore NIV can be useful within palliative care for reduction of dyspnea and improving quality of life. The aim of the guideline update is, taking into account the growing scientific evidence, to outline the advantages as well as the limitations of NIV in the treatment of acute respiratory failure in daily clinical practice and in different indications.

Exacerbations of COPD

“…The numbers needed to treat to reduce mortality was only 8. At present, NIV is a standard of care in COPD patients with acute respiratory failure [3,38,44].…”

Management of sepsis in neutropenic cancer patients: 2018 guidelines from the Infectious Diseases Working Party (AGIHO) and Intensive Care Working Party (iCHOP) of the German Society of Hematology and Medical Oncology (DGHO)

“…Studies from 2001 that included selected immunosuppressed patients with pneumonitis and ARF showed that early initiation of NIV was associated with significant reductions in the rates of endotracheal intubation and serious complications with improved likelihood of survival to hospital discharge [92]. The 2015 published guidelines of the German Society of Pneumology and Ventilatory Medicine recommend a NIV trial in immunosuppressed (hemato-oncological) patients to avoid intubation [93]. In view of this recommendation, however, it is important to point out contraindications and criteria for NIV termination as well as intubation criteria.…”

High flow nasal cannula vs non-invasive ventilation in pediatric ARDS: an RCT

“…Even NIV application is to be limited only to mild forms of ARDS, as its use is associated with higher rates of treatment failure and mortality in severe forms [12].…”