Geiseler J, Kelbel C
Medizinische Klinik IV - Pneumologie, Beatmungs- und Schlafmedizin, Klinikum Vest GmbH, Paracelsus-Klinik, Postfach: 101880, Lipper Weg 11, 45770, Marl, Deutschland.
Medizinsche Klinik I, Klinik für Pneumologie, Gastroenterologie und Intensivmedizin, Klinik am Park, Lünen, Deutschland.
Med Klin Intensivmed Notfmed. 2016 Apr;111(3):208-14. doi: 10.1007/s00063-016-0147-y. Epub 2016 Mar 31.
The international classification of three weaning categories (simple weaning, difficult weaning, prolonged weaning) has been modified in the German weaning guidelines: the group of prolonged weaning has been subclassified into weaning without noninvasive ventilation (NIV), weaning with NIV, if necessary with continuing NIV in the form of home mechanical ventilation, and weaning failure.Strategies to prevent prolonged weaning comprise daily interruption of sedation, daily screening of capability of spontaneous breathing by a spontaneous breathing trial (SBT) and early implementation of NIV instead of continuing invasive mechanical ventilation especially in hypercapnic patients. The comorbidity left heart failure plays a major role in weaning failure and need for re-intubation-in this case early diagnosis and if necessary modification of heart therapy are important.Specialised weaning-centres offer the option for successful weaning for about 50-60 % of patients declared as unweanable by usual intensive care units. A multimodal therapy concept with respiratory therapists, physiotherapists and speech therapy is necessary to reach this goal. In case of weaning failure a professional discharge management to invasive home mechanical ventilation is important. Competent care by physicians in the out-of-hospital area is restricted by the sectoral division of responsibility by the German health care system. Improvement in this area is urgently needed.
德国撤机指南对三种撤机类别（简单撤机、困难撤机、延长撤机）的国际分类进行了修改：延长撤机组被细分为无创通气（NIV）撤机、NIV撤机（必要时以家庭机械通气的形式持续进行NIV）和撤机失败。预防延长撤机的策略包括每日中断镇静、通过自主呼吸试验（SBT）每日筛查自主呼吸能力，以及早期实施NIV而非继续有创机械通气，尤其是在高碳酸血症患者中。合并症左心衰竭在撤机失败和再次插管需求中起主要作用——在这种情况下，早期诊断以及必要时调整心脏治疗很重要。专业的撤机中心为约50%-60%被普通重症监护病房判定为无法撤机的患者提供了成功撤机的选择。要实现这一目标，需要呼吸治疗师、物理治疗师和言语治疗师的多模式治疗理念。在撤机失败的情况下，专业的有创家庭机械通气出院管理很重要。德国医疗保健系统的部门责任划分限制了院外地区医生的专业护理。这一领域迫切需要改进。
