Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · Nov 2012
Review[Ventilation strategies for chronic obstructive pulmonary disease].
Chronic obstructive pulmonary disease (COPD) is considered to be one of the most frequent pulmonary diseases in industrialized countries. Non-invasive ventilation (NIV) is the first choice therapy in acute exacerbations of chronic hypercapnic respiratory failure (AE-COPD). Effective delivery of NIV requires a specialized interdisciplinary team with sufficient monitoring. ⋯ Assisted ventilation modes are preferred over controlled ventilation modes in intubated COPD patients. Settings of respirators have to be aimed at a reduction of intrinsic PEEP and dynamic hyperinflation. This includes sufficient external PEEP, long expiration times and low respiratory frequencies even allowing for permissive hypercapnia.
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Approximately 10% of patients with mechanical ventilation experience prolonged weaning and also have an increased morbidity and mortality. Once spontaneous breathing trials have failed the organ systems responsible should be identified. ⋯ Respiratory and cardiac limitations of weaning can be overcome by reducing the ventilatory load, training of the ventilatory muscles and reducing cardiac workload. A cooperative sedation strategy as well as an early start of weaning and rehabilitation can prevent prolonged weaning in critically ill patients.
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Med Klin Intensivmed Notfmed · Nov 2012
Review[Extracorporeal gas exchange procedures. Differentiated therapy when conventional ventilation reaches the limits].
In recent years the range of products for extracorporeal lung support has substantially expanded. In principle systems generating high blood flow and thus enabling oxygenation and decarboxylation, corresponding to classical extracorporeal membrane oxygenation (ECMO), can be distinguished from low-flow systems, enabling decarboxylation only. ⋯ Indications for extracorporeal decarboxylation, initially thought to enable most protective ventilator settings, have been extended to forms of hypercapnic lung failure and towards avoidance of intubation and mechanical ventilation itself in patients with isolated hypercapnia and failure of non-invasive ventilation. It has to be emphasized however, that due to a still sparse amount of literature and potentially deleterious complications associated with extracorporeal lung support, these kinds of therapies should be reserved for specialized and experienced centers.