Nicht-invasive Beatmung: was gibt es Neues?

Abstract

Non-invasive mechanical ventilation (NIV) has become an essential therapeutic tool for the management of acute respiratory failure (ARF), but is still underrepresented in many intensive care units. In order to promote its more widespread use in the acute care setting, the German "Clinical Practice Guideline: Non-invasive Mechanical Ventilation as Treatment of Acute Respiratory Failure" has been recently published. NIV should be used selectively depending on the cause of respiratory failure and the clinical presentation. Strong evidence supports the use of NIV in hyper-capnic respiratory failure due to COPD exacerbation, with hyper-capnic coma no longer being a contraindication, as well as in the facilitation of weaning of COPD patients requiring intubation. Evidence for NIV as a first-line therapy is much lower in hypoxemic ARF without pre-existing pulmonary or cardiac insufficiency: only in highly selected patients with immunosuppression and after lung surgery could advantages be demonstrated. In hypoxemic ARF, failure of NIV not only occurs much more often compared to hypercapnic ARF, but NIV failure is also associated with increased mortality in these patients. Therefore, the indication for NIV must be checked more carefully and monitoring must be done more frequently than for hypercapnic ARF. With growing experience in the use of such non-invasive ventilation techniques, it will be increasingly used in the acute care setting. For example, in the prevention of extubation failure in patients at risk, endoscopic interventions in patients with ventilatory insufficiency, preoxygenation and bronchoscopy-guided intubation in severe hypoxemia and in palliative treatment.