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Der kritisch chronisch kranke Patient aus pneumologischer Sicht

Chronic critically ill patients from a pneumological perspective

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Zusammenfassung

Patienten mit chronischen Erkrankungen der Lunge, wie chronisch obstruktive Lungenerkrankung (COPD) oder Asthma, werden nach epidemiologischen Schätzungen zunehmen, sodass auch von einer weiter wachsenden Zahl von intensivpflichtigen Patienten mit vorbestehenden pulmonalen Erkrankungen auszugehen ist. Diese Patienten sind meist komplex krank und nach Intubation schwer von der mechanischen Beatmung zu entwöhnen. Nicht selten bedürfen sie nach der akuten Erkrankungsphase weiterhin einer dauerhaften Beatmungsunterstützung. Auch die Frage der Therapiebegrenzung, der Notwendigkeit einer Behandlung mit palliativer Zielsetzung und die Begleitung sowohl der Patienten als auch der Angehörigen am Lebensende sind Herausforderungen an den Intensivmediziner, wenn er akut kranke Patienten mit chronischen Erkrankungen der Lunge behandelt.

Abstract

Epidemiological estimates predict an increase in patients with chronic lung diseases, such as chronic obstructive pulmonary disease (COPD) or asthma; therefore, increasing numbers of patients with preexisting lung diseases who require intensive care treatment are to be expected. These patients tend to have complex disease patterns and are difficult to wean from mechanical ventilation after intubation. It is not uncommon for these patients to need permanent mechanical ventilation after an acute illness. Also the question of limiting therapy, the need for treatment with a palliative objective and supervision of patients as well as their relatives at the end of life is a challenge for intensive care physicians when treating acutely ill patients with chronic pulmonary diseases.

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Literatur

  1. Pritzkuleit R, Beske F, Katalinic A (2010) Erkrankungszahlen in der Pneumologie – eine Projektion bis 2060. Pneumologie 64:535–540

    Article  PubMed  CAS  Google Scholar 

  2. Murray CJ, Lopez AD (1997) Alternative projections of mortality and disability by cause 1990–2020: global burden of disease study. Lancet 349:1498–1504

    Article  PubMed  CAS  Google Scholar 

  3. Devereux G (2006) Abc of chronic obstructive pulmonary disease. Definition, epidemiology, and risk factors. BMJ 332:1142–1144

    Article  PubMed  Google Scholar 

  4. Chandra D, Stamm JA, Taylor B et al (2012) Outcomes of noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease in the united states, 1998–2008. Am J Respir Crit Care Med 185:152–159

    Article  PubMed  Google Scholar 

  5. Gershon AS, Warner L, Cascagnette P et al (2011) Lifetime risk of developing chronic obstructive pulmonary disease: a longitudinal population study. Lancet 378:991–996

    Article  PubMed  Google Scholar 

  6. Buist AS, McBurnie MA, Vollmer WM et al (2007) International variation in the prevalence of copd (the bold study): a population-based prevalence study. Lancet 370:741–750

    Article  PubMed  Google Scholar 

  7. Gold update 2011. http://www.goldcopdorg/

  8. Hurst JR, Vestbo J, Anzueto A et al (2010) Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med 363:1128–1138

    Article  PubMed  CAS  Google Scholar 

  9. Sethi S, Murphy TF (2008) Infection in the pathogenesis and course of chronic obstructive pulmonary disease. N Engl J Med 359:2355–2365

    Article  PubMed  CAS  Google Scholar 

  10. Sethi S, Evans N, Grant BJ, Murphy TF (2002) New strains of bacteria and exacerbations of chronic obstructive pulmonary disease. N Engl J Med 347:465–471

    Article  PubMed  Google Scholar 

  11. Gariani K, Delabays A, Perneger TV, Agoritsas T (2011) Use of brain natriuretic peptide to detect previously unknown left ventricular dysfunction in patients with acute exacerbation of chronic obstructive pulmonary disease. Swiss Med Wkly 141:w13298

    PubMed  CAS  Google Scholar 

  12. Terzano C, Conti V, Di Stefano F et al (2010) Comorbidity, hospitalization, and mortality in copd: results from a longitudinal study. Lung 188:321–329

    Article  PubMed  Google Scholar 

  13. Moua T, Wood K (2008) Copd and pe: a clinical dilemma. Int J Chron Obstruct Pulmon Dis 3:277–284

    PubMed  Google Scholar 

  14. Rizkallah J, Man SF, Sin DD (2009) Prevalence of pulmonary embolism in acute exacerbations of copd: a systematic review and metaanalysis. Chest 135:786–793

    Article  PubMed  Google Scholar 

  15. Chang CL, Robinson SC, Mills GD et al (2011) Biochemical markers of cardiac dysfunction predict mortality in acute exacerbations of copd. Thorax 66:764–768

    Article  PubMed  Google Scholar 

  16. Lindenauer PK, Pekow PS, Lahti MC et al (2010) Association of corticosteroid dose and route of administration with risk of treatment failure in acute exacerbation of chronic obstructive pulmonary disease. JAMA 303:2359–2367

    Article  PubMed  CAS  Google Scholar 

  17. Walters JA, Wang W, Morley C et al (2011) Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev CD006897

  18. Walters JA, Gibson PG, Wood-Baker R et al (2009) Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev CD001288

  19. Rothberg MB, Pekow PS, Lahti M et al (2010) Antibiotic therapy and treatment failure in patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease. JAMA 303:2035–2042

    Article  PubMed  CAS  Google Scholar 

  20. Roberts CM, Stone RA, Buckingham RJ et al (2011) Acidosis, non-invasive ventilation and mortality in hospitalised copd exacerbations. Thorax 66:43–48

    Article  PubMed  CAS  Google Scholar 

  21. Austin MA, Wills KE, Blizzard L et al (2010) Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial. BMJ 341:c5462

    Article  PubMed  Google Scholar 

  22. McLaughlin KM, Murray IM, Thain G, Currie GP (2010) Ward-based non-invasive ventilation for hypercapnic exacerbations of copd: a ‚real-life‘ perspective. QJM 103:505–510

    Article  PubMed  CAS  Google Scholar 

  23. Lightowler JV, Wedzicha JA, Elliott MW, Ram FS (2003) Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: cochrane systematic review and meta-analysis. BMJ 326:185

    Article  PubMed  Google Scholar 

  24. Girault C, Bubenheim M, Abroug F et al (2011) Noninvasive ventilation and weaning in patients with chronic hypercapnic respiratory failure: a randomized multicenter trial. Am J Respir Crit Care Med 184:672–679

    Article  PubMed  Google Scholar 

  25. Kluge S, Braune SA, Engel M et al (2012) Avoiding invasive mechanical ventilation by extracorporeal carbon dioxide removal in patients failing noninvasive ventilation. Intensive Care Med 38(10):1632–1639

    Article  PubMed  Google Scholar 

  26. Fikkers BG, Staatsen M, Hoogen FJ van den et al (2011) Early and late outcome after single step dilatational tracheostomy versus the guide wire dilating forceps technique: a prospective randomized clinical trial. Intensive Care Med 37:1103–1109

    Article  PubMed  Google Scholar 

  27. Gomes Silva BN, Andriolo RB, Saconato H et al (2012) Early versus late tracheostomy for critically ill patients. Cochrane Database Syst Rev 3:CD007271

    Google Scholar 

  28. Funk GC, Breyer MK, Burghuber OC et al (2011) Long-term non-invasive ventilation in copd after acute-on-chronic respiratory failure. Respir Med 105:427–434

    Article  PubMed  Google Scholar 

  29. Heinemann F, Budweiser S, Jorres RA et al (2011) The role of non-invasive home mechanical ventilation in patients with chronic obstructive pulmonary disease requiring prolonged weaning. Respirology 16:1273–1280

    Article  PubMed  Google Scholar 

  30. Raghu G, Collard HR, Egan JJ et al (2011) An official ats/ers/jrs/alat statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med 183:788–824

    Article  PubMed  Google Scholar 

  31. Wuyts WA, Thomeer M, Demedts MG (2011) Newer modes of treating interstitial lung disease. Curr Opin Pulm Med 17:332–336

    Article  PubMed  Google Scholar 

  32. Noble PW, Albera C, Bradford WZ et al (2011) Pirfenidone in patients with idiopathic pulmonary fibrosis (capacity): two randomised trials. Lancet 377:1760–1769

    Article  PubMed  CAS  Google Scholar 

  33. King TE Jr, Pardo A, Selman M (2011) Idiopathic pulmonary fibrosis. Lancet 378:1949–1961

    Article  PubMed  Google Scholar 

  34. Todd NW, Lavania S, Park MH et al (2010) Variable prevalence of pulmonary hypertension in patients with advanced interstitial pneumonia. J Heart Lung Transplant 29:188–194

    Article  PubMed  Google Scholar 

  35. Shorr AF, Wainright JL, Cors CS et al (2007) Pulmonary hypertension in patients with pulmonary fibrosis awaiting lung transplant. Eur Respir J 30:715–721

    Article  PubMed  CAS  Google Scholar 

  36. Song JW, Hong SB, Lim CM et al (2011) Acute exacerbation of idiopathic pulmonary fibrosis: incidence, risk factors and outcome. Eur Respir J 37:356–363

    Article  PubMed  CAS  Google Scholar 

  37. Vidal S, Horra C de la, Martin J et al (2006) Pneumocystis jirovecii colonisation in patients with interstitial lung disease. Clin Microbiol Infect 12:231–235

    Article  PubMed  CAS  Google Scholar 

  38. Kobayashi A, Okamoto H (2012) Treatment of interstitial lung diseases associated with connective tissue diseases. Expert Rev Clin Pharmacol 5:219–227

    Article  PubMed  CAS  Google Scholar 

  39. Al-Hameed FM, Sharma S (2004) Outcome of patients admitted to the intensive care unit for acute exacerbation of idiopathic pulmonary fibrosis. Can Respir J 11:117–122

    PubMed  Google Scholar 

  40. Fumeaux T, Rothmeier C, Jolliet P (2001) Outcome of mechanical ventilation for acute respiratory failure in patients with pulmonary fibrosis. Intensive Care Med 27:1868–1874

    Article  PubMed  CAS  Google Scholar 

  41. Mollica C, Paone G, Conti V et al (2010) Mechanical ventilation in patients with end-stage idiopathic pulmonary fibrosis. Respiration 79:209–215

    Article  PubMed  Google Scholar 

  42. Fuehner T, Kuehn C, Hadem J et al (2012) Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. Am J Respir Crit Care Med 185:763–768

    Article  PubMed  Google Scholar 

  43. Pfeifer M, Schonhofer B (2012) Weaning from mechanical ventilation – new aspects. Dtsch Med Wochenschr 137:644–647

    Article  PubMed  CAS  Google Scholar 

  44. Schweickert WD, Pohlman MC, Pohlman AS et al (2009) Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 373:1874

    Article  PubMed  Google Scholar 

  45. Penrod J, Luhrs C, Livote E et al (2011) Implementation and evaluation of a network-based pilot program to improve palliative care in the intensive care unit. J Pain Symptom Management 42:668–671

    Article  Google Scholar 

  46. Ho L, Engelberg R, Curtis J et al (2001) Comparing clinician ratings of the quality of palliative care in the intensive care unit. Care Med 39:975–983

    Article  Google Scholar 

  47. http://qualitymeasures.Ahrq.Gov.

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Pfeifer, M. Der kritisch chronisch kranke Patient aus pneumologischer Sicht. Med Klin Intensivmed Notfmed 108, 279–284 (2013). https://doi.org/10.1007/s00063-012-0192-0

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