Pneumonien in der neurologischen Intensivmedizin

Zusammenfassung

Neurologische Intensivpatienten haben im Rahmen ihrer neurologischen Grunderkrankung ein deutlich erhöhtes Risiko an einer Pneumonie zu erkranken, wobei beatmungsassoziierte Pneumonien eine wichtige Rolle spielen. Ziel der speziellen neurologischen Intensivmedizin muss es sein, durch adäquate Prophylaxe, Diagnostik und Therapie von Pneumonien unter Berücksichtigung spezifischer intensivneurologischer Faktoren, eine optimale Versorgung dieser Patienten zu gewährleisten. Hierzu ist die Anwendung von evidenzbasierten Leitlinien unentbehrlich, da sie Letalität, Dauer der Intensivpflichtigkeit und entstehende Kosten signifikant senken können. Die adäquate kalkulierte Antibiotikatherapie von Pneumonien erfordert eine Risikoabschätzung bezüglich der Wahrscheinlichkeit einer Infektion mit multiresistenten Erregern. Die Verabreichung nur eines Standardtherapieregimes ohne Einbeziehung weiterer Faktoren beinhaltet das Risiko einer insuffizienten Initialtherapie mit nachfolgender Prognoseverschlechterung. Bei der Wahl der Antibiotika sollte auch das lokale Erreger- und Resistenzspektrum der jeweiligen Institution in die Überlegungen mit einbezogen werden. Die vorliegende Übersichtsarbeit soll die aktuellen Empfehlungen zur Prophylaxe, Diagnose und Therapie insbesondere von bakteriellen nosokomialen Pneumonien vor dem Hintergrund eines intensivneurologischen Patientengutes darstellen. Ambulant erworbene Pneumonien und Lungeninfektionen bei immunsupprimierten Patienten werden kurz dargestellt.

Abstract

Patients on specialized neurological intensive care units carry an increased risk for the development of lung infections. This increased risk is partly attributable to the underlying neurological disease. Ventilator associated pneumonias play an important role in this context. Specialized neurointensive care aims at optimizing patient management by means of appropriate prophylaxis, diagnostics, and therapy, taking also into account important neurological factors. Strict application of evidence-based guidelines is essential for reducing mortality, duration of intensive care treatment, and associated costs of pneumonia. A sufficient primary antibiotic therapy warrants an analysis of a patient's risk to be infected by a drug-multiresistent infectious agent. Application of standard therapy regimes without consideration of patient-specific factors should be avoided as it increases the risk of inadequate therapy and worsening of prognosis. Every intensive care unit should take into account the local distribution of bacteria and resistance patterns when choosing the appropriate antibiotic therapy. This review focuses on up to date recommendations for prophylaxis, diagnostics, and therapy of bacterial lung infection in neurocritical care. Community acquired pneumonias and lung infection in immunocompromised patients will also be briefly discussed.

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