Beatmungsassoziierte Pneumonie – was gibt es Neues?

Kernaussagen

• Die beatmungsassoziierte Pneumonie ist die häufigste nosokomiale Infektion auf Intensivstationen und von hoher medizinischer und ökonomischer Relevanz.

• Als wesentlicher Pathomechanismus gilt die Mikroaspiration. Übersedierung, unnötige Beatmung und das Nichteinhalten krankenhaushygienischer Präventionsmaßnahmen sind die wesentlichen Ursachen für die BAP.

• Zur Vermeidung der BAP stehen viele Interventionsmöglichkeiten mit unterschiedlicher Evidenz zur Verfügung.

• Insbesondere die Einführung einiger ausgewählter, evidenzbasierter Maßnahmen als Bündel hat sich bewährt.

• Unbedingt durchgeführt werden sollten: die Einführung von Sedierungsprotokollen nach S3-Leitlinie und eine strukturierte Entwöhnung von der Beatmung, z. B. über Weaning-Protokolle. Standardhygiene (Händedesinfektion!), kritische Indikationsstellung zur invasiven Beatmung, antiseptische Mundpflege, aktive Surveillance der eigenen BAP-Rate, regelmäßige Schulungen des Personals und die Oberkörperhochlagerung.

• Bei trotz Ausschöpfung aller Basismaßnahmen persistierend hohen BAP-Raten kann der Einsatz weiterer Maßnahmen erwogen werden, wie z. B. die subglottische Sekretabsaugung oder SOD/SDD.

• (Bislang) nicht hinreichend evidenzbasierte Maßnahmen sind: täglicher Wechsel der Beatmungsschläuche, Einsatz von Probiotika, Art der Ernährung, Zeitpunkt der Tracheotomie, Einsatz von kinetischen Betten.

• Der Erfolg der Implementierung infektionspräventiver Maßnahmen sollte durch Teilnahme an Surveillanceprogrammen, wie z. B. KISS, evaluiert werden.

• Literatur

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