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Ventilatorassoziierte Pneumonie

Ventilator-associated pneumonia

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Zusammenfassung

Die ventilatorassoziierte Pneumonie (VAP) ist die häufigste nosokomiale Infektion in der Intensivmedizin und stellt einen unabhängigen Risikofaktor für die Letalität von Intensivpatienten dar. Für ihre Genese sind die durch die maschinelle Beatmung selbst hervorgerufenen mechanischen Schäden des Lungengewebes von geringerer Bedeutung, entscheidender ist demgegenüber die Art der Applikation der Beatmung. So bildet der Endotrachealtubus bei invasiver Beatmung eine Leitschiene für potenziell infektiöses Sekret aus dem Oropharynx, während die Atemwege im Rahmen der nicht-invasiven Beatmung besser vor dieser Mikroaspiration geschützt sind. Zur Prophylaxe der VAP sind deshalb prinzipiell alle Maßnahmen geeignet, die solche Mikroaspirationen verhindern oder die invasive Beatmungsdauer selbst verkürzen. Auch Vorkehrungen zur Keimreduktion im Oropharynx sind so möglicherweise hilfreich. Die Effektivität der Behandlung ist u. a. von einem möglichst frühen Therapiebeginn und damit einer schnellen Diagnose abhängig. In dieser Hinsicht ist die Kombination klinischer, radiologischer und mikrobiologischer Parameter sinnvoll. Bei den therapeutischen Überlegungen steht v. a. die rasche Antibiotikatherapie unter Berücksichtigung individueller Risikofaktoren und lokaler Resistenzen im Vordergrund.

Abstract

Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in critical care medicine and has been shown to be an independent risk factor for mortality. However, ventilator induced lung injury itself is probably only a minor factor predisposing to VAP. In contrast, invasive ventilation using an endotracheal tube is obviously a more important measure. Thus, microaspiration of potentially infectious secretion from the oropharynx into the trachea along the tube has been suggested to be the most critical pathophysiological event in the process of VAP development. Accordingly, non-invasive ventilation provides a decreased risk of VAP. Therefore, all measures aimed at averting microaspiration or shorten the duration of mechanical ventilation are appropriate to prevent VAP. Moreover, oropharyngeal decontamination may be helpful by reducing bacterial colonisation. Effectiveness of therapy depends on early treatment and therefore requires early diagnosis. With this aim combined clinical, radiologic, and microbiological parameters should be taken into account. Adequate antimicrobial therapy in due consideration for individual risk factors and local antibiotic resistance is the most important therapeutic measure.

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  1. Abteilung für Operative Intensivmedizin, Universitätsklinikum der RWTH-Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland

    R. Dembinski & R. Rossaint

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  1. R. Dembinski
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  2. R. Rossaint
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Correspondence to R. Dembinski.

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Dembinski, R., Rossaint, R. Ventilatorassoziierte Pneumonie. Anaesthesist 57, 825–842 (2008). https://doi.org/10.1007/s00101-008-1415-x

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