Hengitysvajaus (äkillinen)

Käypä hoito
5.5.2006
Suomalaisen Lääkäriseuran Duodecimin ja Suomen Anestesiologiyhdistyksen asettama työryhmä

SUOSITUS ON PÄIVITYKSESSÄ

Suosituksen tulostettava versio «»1 (pdf)

Keskeinen sanoma

  • Äkillisen hengitysvajauksen alkuvaiheen ensisijaisia hoitomuotoja ovat noninvasiiviset hengityshoidot naamarin avulla.
  • Hengitysteiden varmistaminen intubaatiolla ja mekaanisen ventilaation aloittaminen perustuu elintoimintojen häiriöiden kokonaisvaltaiseen arviointiin.
  • Hengityslaitehoidossa tulee välttää liian suurta venytyspainetta ja kertahengitystilavuutta.
  • Uloshengitysvaiheen paine (PEEP) tulee säätää happeutumisen ja verenkierron kokonaisarvion perusteella.
  • Hengityskoneesta ja invasiivisesta ilmatiestä vieroittumisen edellytysten päivittäinen, säännönmukainen selvittäminen lyhentää hengityslaitehoidon kestoa.

Tavoite ja kohderyhmä

  • Suosituksen tavoitteena on yhdenmukaistaa ja tarkentaa äkillisen hengitysvajauksen lääkkeettömiä hoitomuotoja.
  • Suosituksessa ei käsitellä hengitysvajaukseen johtavien sairauksien diagnostiikkaa ja hoitoa.
  • Suositus on tarkoitettu erikoissairaanhoidossa, ensihoidossa ja perusterveydenhuollossa aikuisia hengitysvajauspotilaita hoitavalle henkilöstölle.

Määritelmiä

Äkillisen hengitysvajauksen patofysiologia

Taulukko 1. Esimerkkejä tavallisimmista äkilliseen hengitysvajaukseen johtavista sairauksista «Roussos C, Koutsoukou A. Respiratory failure. Eur Respir J (Suppl) 2003;47:3-14»2, «British Thoracic Society Standards of Care Committee. Non-invasive ventilation in acute respiratory failure. Thorax 2002;57:192-211 »16.
Ensisijaisesti ventilaatiovajaus Ensisijaisesti alveolitason kaasujenvaihtohäiriö
Keskushermostoa lamaavat lääkkeet, sairaudet ja vammat Keuhkopöhö
Hermo-lihassairaudet Akuutti keuhkovaurio ja äkillinen hengitysvajausoireyhtymä
Keuhkoahtaumatauti Keuhkokuume
Rintakehän epämuodostumat ja muut rintakehän liikkumista rajoittavat sairaudet Keuhkoveritulppa
Vaikea lihavuus Diffuusit keuhkokudoksen sairaudet

Hengitysvajauksen epidemiologia ja ennuste

Diagnostiikka

Oireet ja löydökset

Tutkimukset

Hoito

Avoimen hengitystien varmistaminen

Sisäänhengitysilman happipitoisuuden (FiO2) suurentaminen spontaanisti hengittävällä potilaalla

CPAP-naamarihoito (continuos positive airway pressure)

Noninvasiivinen ventilaatio (NIV)

Invasiivinen mekaaninen ventilaatio

Hengitysvajaukseen liittyvät ei-ventilatoriset hoidot

Vieroitus hengityslaitehoidosta

Potilaan seuranta hengityslaitehoidon aikana

Kuntoutus

Hoidon toteutus ja porrastus

Arviointikriteerit

  • Äkillistä hengitysvajausta sairastavia potilaita hoitavien erikoissairaanhoidon yksiköiden tulee seurata
    • hengityslaitehoitoa tarvitsevien potilaiden määrää
    • hoidon toteutumista:
      • NIV:llä hoidettavien osuutta
      • invasiivisesti hoidettavien osuutta
      • hengityslaitehoidon kestoa
      • hoidonaikaista kertahengitystilavuutta ja sisäänhengityspainetta
      • sairaalainfektioiden ja erityisesti keuhkokuumeen esiintyvyyttä
      • hengityslaitehoitoon liittyviä komplikaatioita.
    • hengitysvajauspotilaiden hoidon lopputulosta:
      • kuolleisuutta
      • sairaalahoidon kestoa
      • elämänlaatua.

Suomalaisen Lääkäriseuran Duodecimin ja Suomen Anestesiologiyhdistyksen asettama työryhmä

Hengitysvajaus (äkillinen) -suosituksen historiatiedot «Hengitysvajaus (äkillinen), Käypä hoito -suosituksen historiatiedot»1

Puheenjohtaja:

Tero Varpula, LT, apulaisylilääkäri; HUS, Jorvin sairaalan tehohoito-osasto

Jäsenet:

Pirkko E. Brander, dosentti, ylilääkäri; HUS, Hyvinkään sairaalan keuhkosairauksien vastuualue

Tom Bäcklund, LL, sisätautien erikoislääkäri; HUS, Meilahden sairaalan tehovalvontaosasto

Ilkka Parviainen, LT, apulaisylilääkäri; KYS, Operatiiviset tukipalvelut ja tehohoito

Heikki Tikkanen, dosentti; Helsingin yliopiston liikuntalääketieteen yksikkö, (Käypä hoito -toimittaja)

Päivi Valta, LT, vs. osastonylilääkäri; HUS, Jorvin sairaalan leikkausosasto

Sidonnaisuudet:

Pirkko E. Brander: Kutsuttuna luennoitsijana lääkealan yritysten järjestämissä/tukemissa koulutustilaisuuksissa (AstraZeneca, GlaxoSmithKline, MSD, Pfizer). Osallistunut ulkomaisiin kongresseihin lääkealan yritysten rahoituksella (AstraZeneca, GlaxoSmithKline, Pfizer).

Tom Bäcklund: Osallistunut ulkomaiseen kongressiin lääkealan yrityksen rahoittamana (Orion).

Ilkka Parviainen: Osallistunut ulkomaisiin kongresseihin eri lääkealan yritysten rahoituksella (Bayer, EliLilly, Orion Pharma).

Heikki Tikkanen: Luennoitsijana lääkealan yrityksen järjestämässä koulutustilaisuudessa (Astra, GlaxoSmithKline, MSD).

Päivi Valta: Ei sidonnaisuuksia.

Tero Varpula: Osallistunut ulkomaiseen kongressiin lääkealan yrityksen rahoittamana (Orion).

Vastuun rajaus

Käypä hoito -suositukset ovat parhaiden asiantuntijoiden laatimia yhteenvetoja yksittäisten sairauksien diagnostiikan ja hoidon vaikuttavuudesta. Ne eivät korvaa lääkärin tai muun terveydenhuollon ammattilaisen omaa arviota yksittäisen potilaan parhaasta mahdollisesta diagnostiikasta, hoidosta ja kuntoutuksesta hoitopäätöksiä tehtäessä.

Tiedonhakukäytäntö

Käypä hoito -suositukset tehdään näyttöön perustuvan lääketieteen (EBM) periaatteilla. Lue lisää artikkelista nix01853

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