Noninvasive ventilation in respiratory emergencies [Nicht invasive notfallbeatmung]

摘要

Noninvasive ventilation (NIV) is a well established option in the treatment of several respiratory emergencies. Particularly acute exacerbations of chronic obstructive lung disease and pulmonary edema in acute heart failure have been successfully treated by NIV. Both diseases are characterized by a preserved ability to breathe while the workload of breathing can not be sustained. In this situation NIV allows the administration of sufficient amounts of oxygen while the work of breathing is reduced at the same time. In pulmonary edema which is primarily characterized by hypoxemia NIV with a positive endexpiratory pressure (PEEP) of at least 5cmH2O or administration of chronic positive airway pressure (CPAP) both effectively reduce dyspnea and increase oxygen saturation. In acute exacerbations of chronic obstructive lung disease which is characterized by increased dead space ventilation and hypercarbia NIV allows the administration of oxygen and reduces the dead space ventilation by reducing the effects of intrinsic PEEP. In this situation NIV is highly effective in reducing intubation rates and mortality. Thus, NIV is a method which needs to be known by all team members who care for patients with acute respiratory failure in emergency settings.