Die Langzeit-Sauerstoff-Therapie (LTOT) – Was sollten Arzt, Versorger und Krankenkasse wissen?

 

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Zusammenfassung

Die Langzeit-Sauerstoff-Therapie (LTOT) führt bei Patienten mit chronisch respiratorischer Insuffizienz nachweislich zur Prognoseverbesserung. Pathogenetisch sind eine Verbesserung der Oxygenierung, eine Abnahme des pulmonal-arteriellen Drucks sowie eine Abnahme der Atemarbeit von Bedeutung. Aufgrund der Vielfalt und großen Unterschiedlichkeit der LTOT-Systeme ist eine individuelle Einstellung des Patienten auf die Langzeit-Sauerstoff-Therapie notwendig. Zu berücksichtigen sind dabei insbesondere Mobilitätsaspekte. Bei den Applikationsgeräten ist zu unterscheiden zwischen stationären/mobilen Flüssigsauerstoffsystemen sowie stationären/mobilen Konzentratoren. Die Sauerstofftitration sollte individuell, bezogen auf eine Ruhe- und eine Belastungsphase (z. B. 6-Minuten-Gehtest) sowie den Schlaf, vorgenommen werden. Der Einsatz von Spar- bzw. Demandventilen ist kritisch zu prüfen. Er ist nur aufgrund ärztlicher Verordnung gerechtfertigt und bedarf engmaschiger Kontrollen.

Abstract

Long-term oxygen treatment (LTOT) has been demonstrated to improve prognosis in patients with chronic respiratory insufficiency. In terms of pathogenesis, improved oxygenation, reduction of pulmonary artery pressure as well as reduction of respiratory work are important. Since there are considerable differences between the LTOT systems, individually tailored therapy is needed. In particular, the mobility aspects of the patients must be taken into consideration. It is important to distinguish between stationary/mobile devices with a liquid oxygen system and stationary/mobile devices with oxygen concentrator. Oxygen titration should be performed in relation to rest and activity phases (e. g. 6 minute walk test) as well as in relation to the sleep phase. Employing devices with demand-controlled valves should be critically examined. This can be undertaken only under physician orders and requires continuous monitoring.

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