Download PDF
Intensivmedizin up2date 2006; 2(4): E1-E24
DOI: 10.1055/s-2006-944822
Allgemeine Prinzipien der Intensivmedizin
© Georg Thieme Verlag KG Stuttgart · New York

Langzeitbeatmung und Entwöhnung vom Beatmungsgerät

Bernd Schönhofer
Further Information

Publication History

Publication Date:
02 November 2006 (online)

Also available at
    Permissions and Reprints All articles of this category

Kernaussagen

Ursachen für Probleme bei der Entwöhnung vom Beatmungsgerät oder für eine Langzeitbeatmung sind höheres Alter, Polymorbidität und/oder eine Funktionsstörung der Atemmuskulatur. Eine Schwäche der Atemmuskulatur wird begünstigt durch eine schwere COPD, Adipositas permagna, Anämie oder auch durch neuromuskuläre Erkrankungen. Weitere wichtige Faktoren, die zu einer Langzeitbeatmung führen können, sind kardiale Dysfunktionen, eine Mangelernährung oder auch neurophysiologische Störungen.

Spezialisierte Beatmungszentren sind den regulären Intensivstationen bei der schwierigen Entwöhnung überlegen: die Erfolgsrate ist höher, die Kosten sind niedriger. Darüber hinaus bieten sie den Patienten einen höheren Komfort und eine bessere Sicherheit. Problematisch ist jedoch die nicht allgemeingültig geregelte Finanzierung dieser Zentren.

Zur Einschätzung des Entwöhnbarkeit werden Prädiktoren und feste Entwöhnungsprotokolle eingesetzt. Der Erhebung wichtiger Prädiktoren dient der T-Stück-Versuch. Protokollbasierte Entwöhnungsstrategien erhöhen die Erfolgsrate, ersetzen jedoch nicht ein erfahrenes Beatmungsteam.

Übliche Beatmungsformen zur Entwöhnung sind PSV und SIMV. Durch die Verringerung der Atemarbeit kann sich die erschöpfte Atemmuskulatur erholen. Oft wird der Strömungswiderstand eines Trachealtubus durch eine Druckerhöhung nur unzureichend ausgeglichen. Bei absehbaren Entwöhnungsproblemen sollte man daher immer großlumige Tuben verwenden. Standard zur längerfristigen Beatmung ist die Tracheotomie. Weitgehend durchgesetzt hat sich eine Frühtracheotomie in Punktionstechnik.

Die nichtinvasive Beatmung (NIV) spielt insbesondere beim hyperkapnischen Atemversagen eine Rolle. Bei Patienten mit schwerer COPD kann dadurch eine frühzeitige Extubation erreicht werden, nach Extubation wird das Risiko einer erneuten akuten Ateminsuffizienz vermindert. Wichtig ist allerdings, die NIV frühzeitig zu beginnen und nicht erst das manifeste Postextubationsversagen abzuwarten.

Ist eine Entwöhnung im präfinalen Stadium nicht möglich, muss das weitere Vorgehen mit dem Patienten und seinen Angehörigen abgestimmt werden. Dabei müssen auch eine Therapiebegrenzung oder ein Therapieabbruch angesprochen werden. Je nach Wunsch des Patienten kann eine Betreuung durch einen Seelsorger oder einen Psychologen hilfreich sein. Ist der Tod des Patienten absehbar, sollte es einen gesonderten Bereich geben, wo ihm im Beisein der Angehörigen ein würdiges Sterben ermöglicht wird.

Literatur

  • 1 Cox C E, Carson S S, Holmes G M. et al . Increase in tracheostomy for prolonged mechanical ventilation in North Carolina, 1993 - 2002.  Crit Care Med. 2004;  32 2219-2226
    CrossrefPubMedGoogle Scholar
  • 2 Gillespie D J, Marsh H M, Divertie M B. et al . Clinical outcome of respiratory failure in patients requiring prolonged (greater than 24 hours) mechanical ventilation.  Chest. 1986;  90 364-369
    CrossrefPubMedGoogle Scholar
  • 3 MacIntyre N R, Cook D J, Ely E W jr. et al . Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine.  Chest. 2001;  120 375S-395S
    CrossrefPubMedGoogle Scholar
  • 4 Seneff M G, Zimmerman J E, Knaus W A. et al . Predicting the duration of mechanical ventilation. The importance of disease and patient characteristics.  Chest. 1996;  110 469-479
    PubMedGoogle Scholar
  • 5 MacIntyre N R, Epstein S K, Carson S. et al . Management of patients requiring prolonged mechanical ventilation: report of a NAMDRC consensus conference.  Chest. 2005;  128 3937-3954
    CrossrefPubMedGoogle Scholar
  • 6 Epstein S K, Vuong V. Lack of influence of gender on outcomes of mechanically ventilated medical ICU patients.  Chest. 1999;  116 732-739
    CrossrefPubMedGoogle Scholar
  • 7 MacIntyre N R. Respiratory mechanics in the patient who is weaning from the ventilator.  Respir Care. 2005;  50 275-286; discussion 284 - 286
    PubMedGoogle Scholar
  • 8 Schönhofer B, Euteneuer S, Nava S. et al . Survival of mechanically ventilated patients admitted to a specialised weaning centre.  Intensive Care Med. 2002;  28 908-916
    CrossrefPubMedGoogle Scholar
  • 9 Jubran A, Tobin M J. Passive mechanics of lung and chest wall in patients who failed or succeeded in trials of weaning.  Am J Respir Crit Care Med. 1997;  155 916-921
    CrossrefPubMedGoogle Scholar
  • 10 Vassilakopoulos T, Zakynthinos S, Roussos C. Respiratory muscles and weaning failure.  Eur Respir J. 1996;  9 2383-2400
    CrossrefPubMedGoogle Scholar
  • 11 Tobin M J. Advances in mechanical ventilation.  N Engl J Med. 2001;  344 1986-1996
    CrossrefPubMedGoogle Scholar
  • 12 Yang K L, Tobin M J. A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation.  N Engl J Med. 1991;  324 1445-1450
    CrossrefPubMedGoogle Scholar
  • 13 Schönhofer B, Köhler D. Ventilatorische Insuffizienz und hyperkapnische Kompensation inolge chronisch belasteter „Atempumpe”.  Dtsch Med Wochenschr. 1994;  119 1209-1214
    PubMedGoogle Scholar
  • 14 Crieé C P, Laier-Groeneveld G, Huttemann U. Die Atempumpe.  Atemw Lungenkrkh. 1991;  17 94-101
    PubMedGoogle Scholar
  • 15 Criée C-P. Empfehlungen der Deutschen Atemwegsliga zur Messung der inspiratorischen Muskelfunktion.  Pneumologie. 2003;  57 98-100
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Kress J P, Pohlman A S, Alverdy J. et al . The impact of morbid obesity on oxygen cost of breathing (VO(2RESP)) at rest.  Am J Respir Crit Care Med. 1999;  160 883-886
    CrossrefPubMedGoogle Scholar
  • 17 Barchfeld T, Schönhofer B, Wenzel M. et al . [Work of breathing in differentiation of various forms of sleep-related breathing disorders].  Pneumologie. 1997;  51 931-935
    PubMedGoogle Scholar
  • 18 Schönhofer B. The optimal hematocrit- and hemoglobin values in lung diseases.  Wien Klin Wochenschr. 2001;  113 [Suppl 1] 6-8
    PubMedGoogle Scholar
  • 19 Schönhofer Böhrer H, Köhler D. Blood transfusion facilitating difficult weaning from the ventilator.  Anaesthesia. 1998;  53 181-184
    CrossrefPubMedGoogle Scholar
  • 20 Laghi F, Tobin M J. Disorders of the respiratory muscles.  Am J Respir Crit Care Med. 2003;  168 10-48
    CrossrefPubMedGoogle Scholar
  • 21 Windisch W, Hennings E, Sorichter S. et al . Peak or plateau maximal inspiratory mouth pressure: which is best?.  Eur Respir J. 2004;  23 708-713
    CrossrefPubMedGoogle Scholar
  • 22 Kang S W, Bach J R. Maximum insufflation capacity: vital capacity and cough flows in neuromuscular disease.  Am J Phys Med Rehabil. 2000;  79 222-227
    CrossrefPubMedGoogle Scholar
  • 23 Girou E. Controlling nosocomial infection: everyone is concerned.  Arch Dermatol. 2000;  136 785-786
    CrossrefPubMedGoogle Scholar
  • 24 Girou E, Schortgen F, Delclaux C. et al . Association of noninvasive ventilation with nosocomial infections and survival in critically ill patients.  JAMA. 2000;  284 2361-2367
    CrossrefPubMedGoogle Scholar
  • 25 Fagon J Y, Chastre J, Hance A J. et al . Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay.  Am J Med. 1993;  94 281-288
    CrossrefPubMedGoogle Scholar
  • 26 Tolep K, Getch C L, Criner G J. Swallowing dysfunction in patients receiving prolonged mechanical ventilation.  Chest. 1996;  109 167-172
    CrossrefPubMedGoogle Scholar
  • 27 Schönhofer B, Barchfeld T, Haidl P. et al . Scintigraphy for evaluating early aspiration after oral feeding in patients receiving prolonged ventilation via tracheostomy.  Intensive Care Med. 1999;  25 311-314
    CrossrefPubMedGoogle Scholar
  • 28 Leal-Noval S R, Marquez-Vacaro J A, Garcia-Curiel A. et al . Nosocomial pneumonia in patients undergoing heart surgery.  Crit Care Med. 2000;  28 935-940
    PubMedGoogle Scholar
  • 29 Metheny N A, Clouse R E, Chang Y H. et al . Tracheobronchial aspiration of gastric contents in critically ill tube-fed patients: frequency, outcomes, and risk factors.  Crit Care Med. 2006;  34 1007-1015
    CrossrefPubMedGoogle Scholar
  • 30 Chao D C, Scheinhorn D J, Stearn-Hassenpflug M. Impact of renal dysfunction on weaning from prolonged mechanical ventilation.  Crit Care (Lond). 1997;  1 101-104
    CrossrefPubMedGoogle Scholar
  • 31 Scheinhorn D J, Chao D C, Stearn-Hassenpflug M. et al . Ventilator-dependent survivors of catastrophic illnesses: a multicenter outcomes study.  Am J Respir Crit Care Med. 2003;  167 A458
    PubMedGoogle Scholar
  • 32 Srivastava S, Chatila W, Amoateng-Adjepong Y. et al . Myocardial ischemia and weaning failure in patients with coronary artery disease: an update.  Crit Care Med. 1999;  27 2109-2112
    CrossrefPubMedGoogle Scholar
  • 33 Roussos C, Macklem P. Medical Progress: The respiratory muscles.  N Engl J Med. 1982;  307 786-797
    PubMedGoogle Scholar
  • 34 Lemaire F, Teboul J L, Cinotti L. et al . Acute left ventricular dysfunction during unsuccessful weaning from mechanical ventilation.  Anesthesiology. 1988;  69 171-179
    CrossrefPubMedGoogle Scholar
  • 35 Jubran A, Mathru M, Dries D. et al . Continuous recordings of mixed venous oxygen saturation during weaning from mechanical ventilation and the ramifications thereof.  Am J Respir Crit Care Med. 1998;  158 1763-1769
    CrossrefPubMedGoogle Scholar
  • 36 Ambrosino N, Clini E. Long-term mechanical ventilation and nutrition.  Respir Med. 2004;  98 413-420
    CrossrefPubMedGoogle Scholar
  • 37 Celli B R, Cote C G, Marin J M. et al . The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease.  N Engl J Med. 2004;  350 1005-1012
    CrossrefPubMedGoogle Scholar
  • 38 Modawal A, Candadai N P, Mandell K M. et al . Weaning success among ventilator-dependent patients in a rehabilitation facility.  Arch Phys Med Rehabil. 2002;  83 154-157
    CrossrefPubMedGoogle Scholar
  • 39 Hendra K P, Bonis P A, Joyce-Brady M. Development and prospective validation of a model for predicting weaning in chronic ventilator dependent patients.  BMC Pulm Med. 2003;  3 3
    CrossrefPubMedGoogle Scholar
  • 40 Ely E W, Shintani A, Truman B. et al . Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit.  JAMA. 2004;  291 1753-1762
    CrossrefPubMedGoogle Scholar
  • 41 Kollef M H, Levy N T, Ahrens T S. et al . The use of continuous i. v. sedation is associated with prolongation of mechanical ventilation.  Chest. 1998;  114 541-548
    CrossrefPubMedGoogle Scholar
  • 42 Burns A M, Shelly M P, Park G R. The use of sedative agents in critically ill patients.  Drugs. 1992;  43 507-515
    PubMedGoogle Scholar
  • 43 Shelly M P. Sedation, where are we now?.  Intensive Care Med. 1999;  25 137-139
    CrossrefPubMedGoogle Scholar
  • 44 Ramsay M A, Savege T M, Simpson B R. et al . Controlled sedation with alphaxalone-alphadolone.  Br Med J. 1974;  2 656-659
    CrossrefPubMedGoogle Scholar
  • 45 Ely E W, Inouye S K, Bernard G R. et al . Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU).  JAMA. 2001;  286 2703-2710
    CrossrefPubMedGoogle Scholar
  • 46 De Keulenaer B L, Philpot S, Wilkinson M. et al . Central anticholinergic syndrome in the intensive care unit.  Eur J Anaesthesiol. 2004;  21 499-501
    CrossrefPubMedGoogle Scholar
  • 47 Parthasarathy S, Tobin M J. Sleep in the intensive care unit.  Intensive Care Med. 2004;  30 197-206
    CrossrefPubMedGoogle Scholar
  • 48 Cohen I L, Booth F V. Cost containment and mechanical ventilation in the United States.  New Horiz. 1994;  2 283-290
    PubMedGoogle Scholar
  • 49 Indihar F J, Forsberg D P. Experience with a prolonged respiratory care unit.  Chest. 1982;  81 189-192
    CrossrefPubMedGoogle Scholar
  • 50 Pilcher D V, Bailey M J, Treacher D F. et al . Outcomes, cost and long term survival of patients referred to a regional weaning centre.  Thorax. 2005;  60 187-192
    CrossrefPubMedGoogle Scholar
  • 51 Schönhofer B, Haidl P, Kemper P. et al . Entwöhnung vom Respirator („Weaning”) bei Langzeitbeatmung.  Dtsch Med Wochenschr. 1999;  124 1022-1028
    Article in Thieme ConnectPubMedGoogle Scholar
  • 52 Nava S, Rubini F, Zanotti E. et al . Survival and prediction of successful ventilator weaning in COPD patients requiring mechanical ventilation for more than 21 days.  Eur Respir J. 1994;  7 1645-1652
    CrossrefPubMedGoogle Scholar
  • 53 Gracey D R, Naessens J M, Viggiano R W. et al . Outcome of patients cared for in a ventilator-dependent unit in a general hospital.  Chest. 1995;  107 494-499
    CrossrefPubMedGoogle Scholar
  • 54 Scheinhorn D J, Artinian B M, Catlin J L. Weaning from prolonged mechanical ventilation. The experience at a regional weaning center.  Chest. 1994;  105 534-539
    CrossrefPubMedGoogle Scholar
  • 55 Bagley P H, Cooney E. A community-based regional ventilator weaning unit: development and outcomes.  Chest. 1997;  111 1024-1029
    CrossrefPubMedGoogle Scholar
  • 56 Corrado A, Roussos C, Ambrosino N. et al . Respiratory intermediate care units: a European survey.  Eur Respir J. 2002;  20 1343-1350
    CrossrefPubMedGoogle Scholar
  • 57 Schönhofer B. Respiratory high-dependency units in Germany.  Monaldi Arch Chest Dis. 1999;  54 448-451
    PubMedGoogle Scholar
  • 58 Schönhofer B, Wagner T OF. Ort der maschinellen Beatmung im Beatmungszentrum - Intensivstation, Intermediate care oder spezialisierte Normalstation.  Pneumologie. 2006;  (eingereicht)
    PubMedGoogle Scholar
  • 59 Scheinhorn D J, Chao D C, Stearn-Hassenpflug M. et al . Post-ICU mechanical ventilation: treatment of 1,123 patients at a regional weaning center.  Chest. 1997;  111 1654-1659
    CrossrefPubMedGoogle Scholar
  • 60 Gracey D R, Hardy D C, Koenig G E. The chronic ventilator-dependent unit: a lower-cost alternative to intensive care.  Mayo Clin Proc. 2000;  75 445-449
    CrossrefPubMedGoogle Scholar
  • 61 Seneff M G, Wagner D, Thompson D. et al . The impact of long-term acute-care facilities on the outcome and cost of care for patients undergoing prolonged mechanical ventilation.  Crit Care Med. 2000;  28 342-350
    CrossrefPubMedGoogle Scholar
  • 62 Graf J, Graf C, Janssens U. Analysis of resource use and cost-generating factors in a German medical intensive care unit employing the Therapeutic Intervention Scoring System (TISS-28).  Intensive Care Med. 2002;  28 324-331
    CrossrefPubMedGoogle Scholar
  • 63 Schönhofer B, Harms W, Lefering R. et al . Simplified therapeutic intervention scoring system TISS-28 in difficult to wean patients after long-term mechanical ventilation - Difference between general and respiratory ICUs.  . 2006;  (eingereicht)
    PubMedGoogle Scholar
  • 64 Epstein S K, Ciubotaru R L. Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation.  Am J Respir Crit Care Med. 1998;  158 489-493
    CrossrefPubMedGoogle Scholar
  • 65 Schönhofer B. Predictors of weanability.  Monaldi Arch Chest Dis. 2000;  55 339-344
    PubMedGoogle Scholar
  • 66 Brochard L, Rauss A, Benito S. et al . Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation.  Am J Respir Crit Care Med. 1994;  150 896-903
    CrossrefPubMedGoogle Scholar
  • 67 Ely E W, Baker A M, Dunagan D P. et al . Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously.  N Engl J Med. 1996;  335 1864-1869
    CrossrefPubMedGoogle Scholar
  • 68 Esteban A, Alia I, Tobin M J. et al . Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation. Spanish Lung Failure Collaborative Group.  Am J Respir Crit Care Med. 1999;  159 512-518
    CrossrefPubMedGoogle Scholar
  • 69 McLean S E, Jensen L A, Schroeder D G. et al . Improving adherence to a mechanical ventilation weaning protocol for critically ill adults: outcomes after an implementation program.  Am J Crit Care. 2006;  15 299-309
    PubMedGoogle Scholar
  • 70 Vitacca M, Vianello A, Colombo D. et al . Comparison of two methods for weaning patients with chronic obstructive pulmonary disease requiring mechanical ventilation for more than 15 days.  Am J Respir Crit Care Med. 2001;  164 225-230
    CrossrefPubMedGoogle Scholar
  • 71 Kress J P, Pohlman A S, O’Connor M F. et al . Daily interruption of sedative infusion in critically il patients undergoing mechanical ventilation.  N Engl J Med. 2000;  342 1471-1477
    CrossrefPubMedGoogle Scholar
  • 72 Tonnelier J M, Prat G, Le Gal G. et al . Impact of a nurses’ protocol-directed weaning procedure on outcomes in patients undergoing mechanical ventilation for longer than 48 hours: a prospective cohort study with a matched historical control group.  Crit Care. 2005;  9 R83-89
    CrossrefPubMedGoogle Scholar
  • 73 Krishnan J A, Moore D, Robeson C. et al . A prospective, controlled trial of a protocol-based strategy to discontinue mechanical ventilation.  Am J Respir Crit Care Med. 2004;  169 673-678
    CrossrefPubMedGoogle Scholar
  • 74 Knaus W, Draper E, Wagner D. et al . APACHE II: A severity of disease classification system.  Crit Care Med. 1985;  13 818-829
    CrossrefPubMedGoogle Scholar
  • 75 Schönhofer B, Lefering R, Suchi S. et al . Umfrage zur Einschätzung von Score-Systemen durch Intensivmediziner.  Intensivmed. 2002;  39 240-245
    CrossrefPubMedGoogle Scholar
  • 76 Lynn J, Teno J M, Harrell F E jr. Accurate prognostications of death. Opportunities and challenges for clinicians.  West J Med. 1995;  163 250-257
    PubMedGoogle Scholar
  • 77 Schönhofer B, Guo J J, Suchi S. et al . The use of APACHE II prognostic system in difficult-to-wean patients after long-term mechanical ventilation.  Eur J Anaesthesiol. 2004;  21 558-565
    CrossrefPubMedGoogle Scholar
  • 78 Milic-Emili J. Is weaning an art or a science?.  Am Rev Respir Dis. 1986;  134 1107-1108
    PubMedGoogle Scholar
  • 79 Esteban A, Anzueto A, Frutos F. et al . Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study.  JAMA. 2002;  287 345-355
    CrossrefPubMedGoogle Scholar
  • 80 Esteban A, Frutos F, Tobin M J. et al . A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group.  N Engl J Med. 1995;  332 345-350
    CrossrefPubMedGoogle Scholar
  • 81 Flick G R, Bellamy P E, Simmons D H. Diaphragmatic contraction during assisted mechanical ventilation.  Chest. 1989;  96 130-135
    CrossrefPubMedGoogle Scholar
  • 82 Imsand C, Feihl F, Perret C. et al . Regulation of inspiratory neuromuscular output during synchronized intermittent mechanical ventilation.  Anesthesiology. 1994;  80 13-22
    CrossrefPubMedGoogle Scholar
  • 83 Marini J J, Capps J S, Culver B H. The inspiratory work of breathing during assisted mechanical ventilation.  Chest. 1985;  87 612-618
    PubMedGoogle Scholar
  • 84 Marini J J, Smith T C, Lamb V J. External work output and force generation during synchronized intermittent mechanical ventilation. Effect of machine assistance on breathing effort.  Am Rev Respir Dis. 1988;  138 1169-1179
    CrossrefPubMedGoogle Scholar
  • 85 Gibney R T, Wilson R S, Pontoppidan H. Comparison of work of breathing on high gas flow and demand valve continuous positive airway pressure systems.  Chest. 1982;  82 692-695
    PubMedGoogle Scholar
  • 86 Schönhofer B, Mang H, Haidl P. et al . Controlled mechanical ventilation in conscious patients - a concept for patients difficult to wean.  Appl Cardiopulm Pathophysiol. 1996;  6 201-215
    PubMedGoogle Scholar
  • 87 Sassoon C S, Caiozzo V J, Manka A. et al . Altered diaphragm contractile properties with controlled mechanical ventilation.  J Appl Physiol. 2002;  92 2585-2595
    CrossrefPubMedGoogle Scholar
  • 88 Vassilakopoulos T, Petrof B J. Ventilator-induced diaphragmatic dysfunction.  Am J Respir Crit Care Med. 2004;  169 336-341
    CrossrefPubMedGoogle Scholar
  • 89 Sassoon C S, Zhu E, Caiozzo V J. Assist-control mechanical ventilation attenuates ventilator-induced diaphragmatic dysfunction.  Am J Respir Crit Care Med. 2004;  170 626-632
    CrossrefPubMedGoogle Scholar
  • 90 Shapiro M, Wilson R K, Casar G. et al . Work of breathing through different sized endotracheal tubes.  Crit Care Med. 1986;  14 1028-1031
    CrossrefPubMedGoogle Scholar
  • 91 Boque M C, Gualis B, Sandiumenge A. et al . Endotracheal tube intraluminal diameter narrowing after mechanical ventilation: use of acoustic reflectometry.  Intensive Care Med. 2004;  30 2204-2209
    CrossrefPubMedGoogle Scholar
  • 92 Maeda Y, Fujino Y, Uchiyama A. et al . Does the tube-compensation function of two modern mechanical ventilators provide effective work of breathing relief?.  Crit Care. 2003;  7 R92-R97
    CrossrefPubMedGoogle Scholar
  • 93 Michelson A, Schuster B, Kamp H D. Paranasal sinusitis associated with nasotracheal and orotracheal long-term intubation.  Arch Otolaryngol Head Neck Surg. 1992;  118 937-939
    PubMedGoogle Scholar
  • 94 Epstein S K. Anatomy and physiology of tracheostomy.  Respir Care. 2005;  50 476-482
    PubMedGoogle Scholar
  • 95 Dulguerov P, Gysin C, Perneger T V. et al . Percutaneous or surgical tracheostomy: a meta-analysis.  Crit Care Med. 1999;  27 1617-1625
    CrossrefPubMedGoogle Scholar
  • 96 Rumbak M J, Newton M, Truncale T. et al . A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients.  Crit Care Med. 2004;  32 1689-1694
    CrossrefPubMedGoogle Scholar
  • 97 Antonelli M, Michetti V, Di Palma A. et al . Percutaneous translaryngeal versus surgical tracheostomy: A randomized trial with 1-yr double-blind follow-up.  Crit Care Med. 2005;  33 1015-1020
    CrossrefPubMedGoogle Scholar
  • 98 Heffner J E, Hess D. Tracheostomy management in the chronically ventilated patient.  Clin Chest Med. 2001;  22 55-69
    CrossrefPubMedGoogle Scholar
  • 99 Berra L, De Marchi L, Panigada M. et al . Evaluation of continuous aspiration of subglottic secretion in an in vivo study.  Crit Care Med. 2004;  32 2071-2078
    CrossrefPubMedGoogle Scholar
  • 100 Rosenblüh J, Schönhofer B, Kemper P. et al . Bedeutung von Platzhaltern tracheotomierter Patienten während der Entwöhnungsphase nach Langzeitbeatmung.  Med Klin. 1994;  89 S61-S63
    PubMedGoogle Scholar
  • 101 Ceriana P, Carlucci A, Navalesi P. et al . Weaning from tracheotomy in long-term mechanically ventilated patients: feasibility of a decisional flowchart and clinical outcome.  Intensive Care Med. 2003;  29 845-848
    PubMedGoogle Scholar
  • 102 Nava S, Ambrosino N, Clini E. et al . Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease. A randomized, controlled trial.  Ann Intern Med. 1998;  128 721-728
    CrossrefPubMedGoogle Scholar
  • 103 Ferrer M, Esquinas A, Arancibia F. et al . Noninvasive ventilation during persistent weaning failure: a randomized controlled trial.  Am J Respir Crit Care Med. 2003;  168 70-76
    CrossrefPubMedGoogle Scholar
  • 104 Kilger E, Briegel J, Haller M. et al . Effects of noninvasive positive pressure ventilatory support in non-COPD patients with acute respiratory insufficiency after early extubation.  Intensive Care Med. 1999;  25 1374-1380
    CrossrefPubMedGoogle Scholar
  • 105 Carlucci A, Gregoretti C, Squadrone V. et al . Preventive use of non-invasive mechanical ventilation to avoid post-Extubation respiratory failure: a randomised controlled study.  Eur Respir J. 2001;  18 suppl 33 306
    PubMedGoogle Scholar
  • 106 Hilbert G, Gruson D, Portel L. et al . Noninvasive pressure support ventilation in COPD patients with postextubation hypercapnic respiratory insufficiency.  Eur Respir J. 1998;  11 1349-1353
    CrossrefPubMedGoogle Scholar
  • 107 Nava S, Gregoretti C, Fanfulla F. et al . Noninvasive ventilation to prevent respiratory failure after extubation in high-risk patients.  Crit Care Med. 2005;  33 2465-2470
    CrossrefPubMedGoogle Scholar
  • 108 Ferrer M, Valencia M, Nicolas J M. et al . Early noninvasive ventilation averts extubation failure in patients at risk: a randomized trial.  Am J Respir Crit Care Med. 2006;  173 164-170
    CrossrefPubMedGoogle Scholar
  • 109 Keenan S P, Powers C, McCormack D G. et al . Noninvasive positive-pressure ventilation for postextubation respiratory distress: a randomized controlled trial.  JAMA. 2002;  287 3238-3244
    CrossrefPubMedGoogle Scholar
  • 110 Esteban A, Frutos-Vivar F, Ferguson N D. et al . Noninvasive positive-pressure ventilation for respiratory failure after extubation.  N Engl J Med. 2004;  350 2452-2460
    CrossrefPubMedGoogle Scholar
  • 111 Corwin H L, Gettinger A, Pearl R G. et al . The CRIT Study: Anemia and blood transfusion in the critically ill-current clinical practice in the United States.  Crit Care Med. 2004;  32 39-52
    CrossrefPubMedGoogle Scholar
  • 112 Shorr A F, Jackson W L, Kelly K M. et al . Transfusion practice and blood stream infections in critically ill patients.  Chest. 2005;  127 1722-1728
    CrossrefPubMedGoogle Scholar
  • 113 Gong M N, Thompson B T, Williams P. et al . Clinical predictors of and mortality in acute respiratory distress syndrome: potential role of red cell transfusion.  Crit Care Med. 2005;  33 1191-1198
    CrossrefPubMedGoogle Scholar
  • 114 Schönhofer B, Wenzel M, Geibel M. et al . Blood transfusion and lung function in chronically anemic patients with severe chronic obstructive pulmonary disease.  Crit Care Med. 1998;  26 1824-1828
    CrossrefPubMedGoogle Scholar
  • 115 Schönhofer B, Geibel M, Stickeler P. et al . Endoscopic placement of a tracheal oxygen catheter: a new technique.  Intensive Care Med. 1997;  23 445-449
    CrossrefPubMedGoogle Scholar
  • 116 Schönhofer B, Köhler D. Stellenwert von oral appliziertem retardiertem Morphin zur Therapie des schwergradigen Lungenemphysems vom Pink-Puffer-Typ.  Dtsch Med Wochenschr. 1998;  123 1433-1438
    PubMedGoogle Scholar
  • 117 Barr J, Hecht M, Flavin k E. et al . Outcomes in Critically Ill Patients Before and After the Implementation of an Evidence-Based Nutritional Management Protocol.  Chest. 2004;  125 1446-1457
    CrossrefPubMedGoogle Scholar
  • 118 Bassili H R, Deitel M. Nutritional support in long term intensive care with special reference to ventilator patients: a review.  Can Anaesth Soc. 1991;  28 17-21
    PubMedGoogle Scholar
  • 119 Bolton C F, Breuer A C. Critical illness polyneuropathy.  Muscle Nerve. 1999;  22 419-424
    CrossrefPubMedGoogle Scholar
  • 120 Burdet L, de Muralt B, Schutz Y. et al . Administration of growth hormone to underweight patients with chronic obstructive pulmonary disease. A prospective randomized controlled study.  Am J Respir Crit Care Med. 1997;  156 1800-1806
    PubMedGoogle Scholar
  • 121 Ferreira I, Verreschi I, Nery L. et al . The influence of 6 months of oral anabolic steroids on body mass and respiratory muscles in undernourished COPD patients.  Chest. 1998;  114 19-28
    CrossrefPubMedGoogle Scholar
  • 122 Schols A MW, Soeters P B, Mostert R. et al . Physiologic effects of nutritional support and anabolic steroids in patients with chronic obstructive pulmonary disease. A placebo-controlled randomized trial.  Am J Respir Crit Care Med. 1995;  152 1268-1274
    PubMedGoogle Scholar
  • 123 Artinian V, Krayem H, DiGiovine B. Effects of early enteral feeding on the outcome of critically ill mechanically ventilated medical patients.  Chest. 2006;  129 960-967
    CrossrefPubMedGoogle Scholar
  • 124 Kostadima E, Kaditis A G, Alexopoulos E I. et al . Early gastrostomy reduces the rate of ventilator-associated pneumonia in stroke or head injury patients.  Eur Respir J. 2005;  26 106-111
    CrossrefPubMedGoogle Scholar
  • 125 Siobal M S, Kallet R H, Kivett V A. et al . Use of dexmedetomidine to facilitate extubation in surgical intensive-care-unit patients who failed previous weaning attempts following prolonged mechanical ventilation: a pilot study.  Respir Care. 2006;  51 492-496
    PubMedGoogle Scholar
  • 126 Granberg Axell A I, Malmros C W, Bergbom I L. et al . Intensive care unit syndrome/delirium is associated with anemia, drug therapy and duration of ventilation treatment.  Acta Anaesthesiol Scand. 2002;  46 726-731
    CrossrefPubMedGoogle Scholar
  • 127 Martin U J, Hincapie L, Nimchuk M. et al . Impact of whole-body rehabilitation in patients receiving chronic mechanical ventilation.  Crit Care Med. 2005;  33 2259-2265
    CrossrefPubMedGoogle Scholar
  • 128 Bach J R. Update and Perspective on Noninvasive Respiratory Muscle Aids. Part 2: Expiratory Aids.  Chest. 1994;  105 1538-1544
    CrossrefPubMedGoogle Scholar
  • 129 Chatwin M, Ross E, Hart N. et al . Cough augmentation with mechanical insufflation/exsufflation in patients with neuromuscular weakness.  Eur Respir J. 2003;  21 502-508
    CrossrefPubMedGoogle Scholar
  • 130 Gosselink R, Bott J, Connor M. et al . Physiotherapy for adult patients with critical care.  Intensive Care Med. 2006; 
    PubMedGoogle Scholar
  • 131 Karg O, Bonnet R, Magnussen H. et al . Respiratory Therapist - Atmungstherapeut - Einführung eines neuen Berufsbildes.  Pneumologie. 2004;  58 854-857
    Article in Thieme ConnectPubMedGoogle Scholar
  • 132 Chatila W, Kreimer D T, Criner G J. Quality of life in survivors of prolonged mechanical ventilatory support.  Crit Care Med. 2001;  29 737-742
    CrossrefPubMedGoogle Scholar
  • 133 Hopkins R O, Weaver L K, Collingridge D. et al . Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome.  Am J Respir Crit Care Med. 2005;  171 340-347
    CrossrefPubMedGoogle Scholar
  • 134 Euteneuer S, Windisch W, Suchi S. et al . Health-related quality of life in patients with chronic respiratory failure after long-term mechanical ventilation.  Respir Med. 2006;  100 477-486
    PubMedGoogle Scholar
  • 135 Hurel D, Loirat P, Saulnier F. et al . Quality of life 6 months after intensive care: results of a prospective multicenter study using a generic health status scale and a satisfaction scale.  Intensive Care Med. 1997;  23 331-337
    CrossrefPubMedGoogle Scholar
  • 136 Granja C, Lopes A, Moreira S. et al . Patients’ recollections of experiences in the intensive care unit may affect their quality of life.  Crit Care. 2005;  9 R96-R109
    CrossrefPubMedGoogle Scholar
  • 137 Stoller J K. Establishing Clinical Unweanability.  Respir Care. 1991;  36 186-198
    PubMedGoogle Scholar
  • 138 Schönhofer B, Köhler D, Kutzer K. Ethische Betrachtungen zur Beatmungsmedizin unter besonderer Berücksichtigung des Lebensendes.  Pneumologie. 2006;  (eingereicht)
    PubMedGoogle Scholar
  • 139 Ferrand E, Lemaire F, Regnier B. et al . Discrepancies between perceptions by physicians and nursing staff of intensive care unit end-of-life decisions.  Am J Respir Crit Care Med. 2003;  167 1310-1315
    CrossrefPubMedGoogle Scholar
  • 140 Thomas E J, Sexton J B, Helmreich R L. Discrepant attitudes about teamwork among critical care nurses and physicians.  Crit Care Med. 2003;  31 956-959
    CrossrefPubMedGoogle Scholar
  • 141 van der Heide A, Deliens L, Faisst K. et al . End-of-life decision-making in six European countries: descriptive study.  Lancet. 2003;  362 345-350
    CrossrefPubMedGoogle Scholar
  • 142 Tulsky J A, Chesney M A, Lo B. How do medical residents discuss resuscitation with patients?.  J Gen Intern Med. 1995;  10 436-442
    CrossrefPubMedGoogle Scholar
  • 143 Lo B, Ruston D, Kates L W. et al . Discussing religious and spiritual issues at the end of life: a practical guide for physicians.  JAMA. 2002;  287 749-754
    CrossrefPubMedGoogle Scholar
  • 144 Gianakos D. Terminal weaning.  Chest. 1995;  108 1405-1406
    PubMedGoogle Scholar
  • 145 Chao D C, Stearn-Hassenpflug M, Scheinhorn D J. The challenge of prolonged mechanical ventilation: a shared global experience.  Respir Care. 2003;  48 668-669
    PubMedGoogle Scholar

Prof. Dr. med. Bernd Schönhofer

Abteilung für Pneumologie und internistische Intensivmedizin

Klinikum Region Hannover GmbH · Krankenhaus Oststadt-Heidehaus · Podbielskistraße 380 · 30659 Hannover

Email: Bernd.Schoenhofer@t-online.de

      >