Abstract
Nosocomial pneumonia is one of the leading entities of nosocomial infections in Germany and worldwide with invasive ventilation being one of the major risk factors. However nosocomial pneumonia without ventilator support is an underappreciated complication as demonstrated by prevalence studies of the European Centre for Disease Control in 2011 and 2016. Major general risk factors include old age, multi-morbidity, preexisting pulmonary disease, immunosuppression and abdominal or thoracic surgery. Evidence based prevention measures for ventilated patients include hand hygiene, aseptic handling techniques of the ventilator circuit, subglottic suctioning for patients intubated more than 72 hours, cuff pressure control, mouth and dental care, daily spontaneous breathing trials, use of sedation protocols and head of bed 30–45 degrees. For non-ventilated patients early mobilization and/or frequent position changes, correct use of feeding tubes and mouth care are key components. In preoperative patients training of a simple breathing exercise combined with mnemonic aids for its use in the postoperative period has been proven to be helpful.
Die nosokomiale Pneumonie ist die häufigste im Krankenhaus erworbene Infektion in Deutschland. Sie betrifft nicht nur beatmete, sondern auch nicht beatmete Patienten. Folgen sind eine längere stationäre Verweildauer, eine erhöhte Mortalität und hohe Behandlungskosten. Dieser Beitrag zeigt neben einem Überblick zu Ätiologie, Diagnostik und Therapie die derzeitigen Präventionsempfehlungen auf.
Schlüsselwörter
Frühmobilisation - postoperative pulmonale Komplikationen - Präventionsbündel - Cuffdruckmessung - early onset
Key words
early mobilization - postoperative pulmonary complications - prevention bundles - cuff pressure control - early onset
