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Ventilation, NIV & oxygen

Airway & Ventilation

For healthcare professionals. This information does not replace clinical judgement in the individual case; the current summary of product characteristics and the guidelines cited are authoritative.

Medically reviewed: Dr. med. univ. Daniel Pehböck, DESA, 03.11.2026

Ventilation, NIV & oxygen: Oxygen – target ranges, Devices and flow rates, High-flow oxygen (HFNC), NIV and CPAP, Ventilation after intubation – initial settings for adults, Asthma and COPD – air trapping – concise for emergency, anaesthesia and intensive care teams, with sources and medically reviewed.

What the chapter covers

  1. Oxygen – target ranges
  2. Devices and flow rates
  3. High-flow oxygen (HFNC)
  4. NIV and CPAP
  5. Ventilation after intubation – initial settings for adults
  6. Asthma and COPD – air trapping
  7. ARDS – in brief
  8. Children
  9. Capnography
  10. Problems during ventilation
  11. Transport ventilation

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Sources and guidelines

  1. Westhoff M, Neumann P, Geiseler J et al. S2k-Leitlinie Nichtinvasive Beatmung als Therapie der akuten respiratorischen Insuffizienz (DGP mit weiteren Fachgesellschaften), AWMF-Register 020-004, Version 3.3, Stand 30.12.2022, gültig bis 29.12.2027. Pneumologie 2024;78:453–514, online 13.10.2023.
  2. Zehn Kernaussagen der S2k-Leitlinie Nichtinvasive Beatmung als Therapie der akuten respiratorischen Insuffizienz („Ten key messages of the S2k guideline on noninvasive mechanical ventilation in acute respiratory failure“), frei zugänglich über PubMed Central: NIV-Versuch beim hyperkapnischen Koma im Einzelfall, kein relevanter Unterschied NIV vs. High-Flow bei hypoxämischer ARI mit PaO₂/FiO₂ > 150 mmHg, hohes Versagen der NIV beim schweren ARDS, CPAP/NIV beim kardialen Lungenödem, NIV zur Präoxygenierung.
  3. Westhoff M, Schönhofer B, Neumann P et al. S3-Leitlinie Nicht-invasive Beatmung als Therapie der akuten respiratorischen Insuffizienz. Pneumologie 2015;69:719–756 (Vorgängerfassung; Liste absoluter und relativer Kontraindikationen)
  4. Rochwerg B, Brochard L, Elliott MW et al. Official ERS/ATS clinical practice guidelines.
  5. American Thoracic Society. Noninvasive Respiratory Support for Adult Patients with Acute Respiratory Failure.
  6. Davidson AC, Banham S, Elliott M et al. BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults. Thorax 2016;71 Suppl 2:ii1–ii35 (COPD: EPAP 3 cmH₂O, höher bei Schlafapnoe; IPAP 15 cmH₂O, bei pH < 7,25 20 cmH₂O; über 10–30 min auf 20–30 cmH₂O titrieren, ohne Experten max. 30)
  7. Masip J, Peacock WF, Price S et al. (Acute Heart Failure Study Group of the ACCA/ESC). Indications and practical approach to non-invasive ventilation in acute heart failure. Eur Heart J 2018;39:17–25 (CPAP präklinisch einfacher, Druckunterstützung mit PEEP bei relevanter Hyperkapnie).
  8. Carteaux G, Millán-Guilarte T, De Prost N et al. Failure of noninvasive ventilation for de novo acute hypoxemic respiratory failure.
  9. Oczkowski S, Ergan B, Bos L et al. ERS clinical practice guidelines.
  10. Roca O, Caralt B, Messika J et al. An index combining respiratory rate and oxygenation to predict outcome of nasal high-flow therapy. Am J Respir Crit Care Med 2019;199:1368–1376 (ROX-Index = SpO₂/FiO₂ ÷ Atemfrequenz; ≥ 4,88 nach 2, 6 bzw. 12 h spricht gegen eine Intubation).
  11. Franklin D, Babl FE, Schlapbach LJ et al. (PARIS). A randomized trial of high-flow oxygen therapy in infants with bronchiolitis. N Engl J Med 2018;378:1121–1131 (High-Flow 2 l/kg/min bei Säuglingen).
  12. DGAI (federführend) mit weiteren Fachgesellschaften. S3-Leitlinie Invasive Beatmung und Einsatz extrakorporaler Verfahren bei akuter respiratorischer Insuffizienz, AWMF-Register 001-021, Version 2.0, Stand 18.08.2025 (Vorgänger 12/2017; 28 Empfehlungen geändert, 22 neu)
  13. Grasselli G, Calfee CS, Camporota L et al. ESICM guidelines on acute respiratory distress syndrome.
  14. Matthay MA, Arabi Y, Arroliga AC et al. A New Global Definition of Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med 2024;209:37–47 (Erweiterung der Berlin-Definition.
  15. Amato MBP, Meade MO, Slutsky AS et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med 2015;372:747–755 (Driving Pressure als stärkster beatmungsbezogener Prädiktor; Beobachtungsdaten).
  16. Emeriaud G, López-Fernández YM, Iyer NP et al. Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2). Pediatr Crit Care Med 2023;24:143–168 (Tidalvolumen im physiologischen Bereich, bei schlechter Compliance niedriger; Plateau ≤ 28 cmH₂O, bei steifer Thoraxwand 29–32; Driving Pressure ≤ 15 cmH₂O)
  17. Oddo M, Feihl F, Schaller MD, Perret C. Management of mechanical ventilation in acute severe asthma.
  18. ARDS Network. Ventilation with lower tidal volumes … N Engl J Med 2000;342:1301–8 (Predicted Body Weight).
  19. Soar J, Böttiger BW et al. European Resuscitation Council Guidelines 2025 Adult Advanced Life Support. Resuscitation 2025;215 Suppl 1:110769 (Korrigendum 2026).
  20. Djakow J, Turner NM, Skellett S et al. European Resuscitation Council Guidelines 2025 Paediatric Life Support. Resuscitation 2025;215 Suppl 1:110767.
  21. Nolan JP, Sandroni C et al. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2025 Post-Resuscitation Care. Resuscitation 2025 / Intensive Care Med 2025;51:2213–2288.
  22. McDonagh TA et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021;42:3599–3726; 2023 Focused Update, Eur Heart J 2023;44:3627–3639.
  23. Byrne RA, Rossello X, Coughlan JJ et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J 2023;44:3720–3826.
  24. Gibbs KW, Semler MW, Driver BE et al. (PREOXI). Noninvasive ventilation for preoxygenation during emergency intubation. N Engl J Med 2024;390:2165–2177.
  25. Chrimes N, Higgs A, Hagberg CA et al. Preventing unrecognised oesophageal intubation.
  26. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management, and Prevention of COPD.
  27. Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention.
  28. Summaries of product characteristics of authorised products – product and section for each dose in the app.