Nicht-invasive Beatmung als Therapie der akuten respiratorischen Insuffizienz

Westhoff, M.; Schönhofer, Bernd; Neumann, Peter; Bickenbach, Johannes; Barchfeld, T.; Becker, Heinrich F.; Dubb, Rolf; Fuchs, Hans; Heppner, Hans-Jürgen; Janssens, Uwe; Jehser, Thomas; Karg, O.; Kilger, Erich; Köhler, H.; Köhnlein, Thomas; Max, M.; Meyer, F. J.; Müllges, Wolfgang; Putensen, Christian; Schreiter, D.; Storre, Jan Hendrik; Windisch, Wolfram

doi:10.1055/s-0034-1393309

Cited by 102 publications

(79 citation statements)

References 113 publications

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“…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].…”

Section: Noninvasive Ventilationmentioning

confidence: 99%

Exacerbations of COPD

2018

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Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. While COPD is a mainly chronic disease, a substantial number of patients suffer from exacerbations. Severe exacerbations are related to a significantly worse survival outcome. This review summarises the current knowledge on the different aspects of COPD exacerbations. The impact of risk factors and triggers such as smoking, severe airflow limitation, bronchiectasis, bacterial and viral infections and comorbidities is discussed. More severe exacerbations should be treated with β-agonists and anticholinergics as well as systemic corticosteroids. Antibiotic therapy should only be given to patients with presumed bacterial infection. Noninvasive ventilation is indicated in patients with respiratory failure. Smoking cessation is key to prevent further COPD exacerbations. Other aspects include choice of pharmacotherapy, including bronchodilators, inhaled corticosteroids, phosphodiesterase-4 inhibitors, longterm antibiotics and mucolytics. Better education and self-management as well as increased physical activity are important. Influenza and pneumococcal vaccination is recommended. Treatment of hypoxaemia and hypercapnia reduce the rate of COPD exacerbations, while most interventional bronchoscopic therapies increase exacerbation risk within the first months after the procedure.

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“…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].…”

Section: Noninvasive Ventilationmentioning

confidence: 99%

Exacerbations of COPD

2018

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“…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.…”

Section: Mechanical Ventilationmentioning

confidence: 99%

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)

et al. 2019

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Sepsis and septic shock are major causes of mortality during chemotherapy-induced neutropenia for malignancies requiring urgent treatment. Thus, awareness of the presenting characteristics and prompt management is most important. Improved management of sepsis during neutropenia may reduce the mortality of cancer therapies. However, optimal management may differ between neutropenic and non-neutropenic patients. The aim of the current guideline is to give evidence-based recommendations for hematologists, oncologists, and intensive care physicians on how to manage adult patients with neutropenia and sepsis.

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“…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].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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Introduction: Pediatric Acute Respiratory Distress syndrome (PARDS) has been re-defined (2015) as per the final recommendations of the Pediatric Acute Lung Injury Consensus Conference. The use of high flow nasal cannula is a promising treatment but its efficacy compared with non invasive ventilation (NIV) is not known. Aims and Objectives:The current study was undertaken to study the efficacy of high flow nasal cannula compared with NIV in PARDS. Methods: This was a pilot randomized controlled trial done in the PICU of a tertiary care teaching hospital over 10 months (December 2017 -September 2018). All patients aged 1-18 years of age, who presented with or developed ARDS during their course of hospitalization, and who fulfilled the inclusion criteria, were randomized to receive HFNC and Continuous Positive Airway Pressure (NIV) as the initial respiratory support. Details were noted in a pre-designed standardized data collection form, entered into MS-EXCEL worksheet 2013 and analyzed using the Epi info software version 7.2.0.1. Results: A total of 40 patients were enrolled, 20 in each arm.Of these majority (25/40=62.5%) were boys. Majority of these patients were from rural or semi-urban areas (28/40=70.0%) and belonged to low socio-economic class (33/40= 82.5%) patients.Underlying diagnosis was sepsis in the majority (27/40=67.5%) patients.Twenty one (23/40=57.5%) patients had co-existent pneumonia. Development of hemodynamic instability approached statistical significance in being low in HFNC group compared with the CPAP group (p=0.07; OR 0.206, 95% CI 0.036-0.159). Subsequent requirement of invasive ventilation was also low in HFNC group compared with CPAP group and approached significance (p=0.09; OR 1.653, 95% CI 0.074-1.246). Total duration of respiratory support (p=0.62) was comparable in both the groups. Conclusion: HFNC is efficacious in managing PARDS. Subsequent requirement of invasive ventilation and hemodynamic deterioration was significantly low with HFNC compared with NIV (CPAP).

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Nicht-invasive Beatmung als Therapie der akuten respiratorischen Insuffizienz

Cited by 102 publications

References 113 publications

Exacerbations of COPD

Exacerbations of COPD

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)

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

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