Die nichtinvasive Beatmung als Therapie der akut respiratorischen Insuffizienz

Over the past few years, noninvasive ventilation (NIV) with only PEEP (CPAP) or pressure support with PEEP has been increasingly applied during various episodes of acute respiratory failure. This led to a relevant number of published clinical studies dealing with the application of this technique in the different varieties of an acute respiratory insufficiency, particularly in patients with an acute exacerbation of COPD and in those presenting with an acute cardiogenic pulmonary oedema. Strongly supported through pathophysiological, clinical and epidemiological data, NIV is currently considered an evidence-based applied treatment in both conditions. Considering the encouraging consequences on the decline of hospital-acquired infections (ventilator-associated pneumonia) through the reduction of intubation rate and the potential positive effects on lung tissue recruitment, NIV has become an attractive option in other acute respiratory failures like severe diffuse pneumonia, ALI (acute lung injury) or even ARDS. However, in spite of recent promising results, the application of noninvasive pressure support ventilation in patients with severe hypoxaemic non-hypercapnic acute respiratory failure still remains controversial and potentially predictive of a high failure rate predominantly in patients with a coexisting bacteraemia associated with distant organ dysfunction.