Abstract
In patients with home ventilation, there is a markedly higher probability for lower respiratory infections or pneumonia and severe courses due to comorbidity. Tracheobronchitis and pneumonia are often difficult to distinguish. Tracheobronchitis with pronounced secretion which can’t be controlled otherwise can be an indication for antimicrobial therapy.
There are no data available in order to establish a recommendation for the initial empiric calculated antimicrobial therapy in patients with home ventilation. However, risk factors for multi drug resistance (MDR) are mostly present and should be considered in the selection of antimicrobial therapy.
The principles of antimicrobial therapy are also essential for infections in home ventilation: judicious indication, dosage, microbiological investigation, de-escalation and duration of therapy. In individual cases, inhaled antimicrobials are an option.
In order to avoid lower airway infections, adherence to hygienic standards is essential. In addition, invasive ventilation should be avoided wherever possible. If possible, weaning attempts are to be repeated given that invasive ventilation is a risk factor for pneumonia caused by aspiration.
Respiratorische Infektionen bei Patienten mit außerklinischer Beatmung sind bisher nicht hinreichend untersucht worden. Daher liegen zu dieser Patientengruppe nur wenige Daten vor, durch die sich Empfehlungen für die Praxis herleiten lassen. Im Folgenden soll der Hintergrund skizziert werden, auf dem die Behandlung von außerklinisch beatmeten Patienten mit pulmonalen Infektionen erfolgen kann.
Schlüsselwörter
Invasive Beatmung - Pneumonie - Tracheobronchitis - MRE - Sekretmanagement
Key words
invasive ventilation - pneumonia - tracheobronchiti - MDR - management of secretion
