Empfehlungen zur Prävention nosokomialer Pneumonien

Zusammenfassung

Nosokomiale Pneumonien sind auf Intensivstationen die häufigsten nosokomialen Infektionen. Sie führen zu erhöhter Letalität, einer durchschnittlichen Verlängerung der Liegedauer und einer Erhöhung der Kosten. Daher ist es sinnvoll, gezielt wirksame Präventionsmaßnahmen anzuwenden. Die kürzlich durch die CDC publizierten Leitlinien haben die Studien der letzten zehn Jahre zur Prävention der Pneumonie umfassend berücksichtigt, so dass die „Evidenz” für viele Empfehlungen gesteigert werden konnte. Die wichtigsten dieser Maßnahmen sind in diesem Artikel unter Nennung der jeweiligen Evidenzklassifizierung aufgeführt. An Neuerungen werden vom HICPAC herausgestellt: Orotacheale Intubation der nasotrachealen vorziehen, noninvasive Beatmung einsetzen, um die Notwendigkeit und Dauer der endotrachealen Intubation zu reduzieren, Wechsel der Beatmungsschläuche, nur wenn die Funktionsfähigkeit eingeschränkt ist, bzw. diese sichtbar verschmutzt sind und Verwendung von endotrachealen Tuben mit dorsalem Lumen zur Absaugung respiratorischer Sekrete (subglottische Absaugung).

Abstract

Because of the high morbidity and mortality associated with health-care-associated pneumonia, it is important to implement evidence-based prevention measures. Recently by CDC published Guidelines for Preventing Health-Care-Associated Pneumonia describe prevention measures based on evaluated studies, randomized controlled trials or metaanalyses. In this paper the most important prevention measures are given, as well as the evidence classification. ”Among the changes in the recommendations to prevent bacterial pneumonia, especially ventilator-associated pneumonia, are the preferential use of or tracheal rather than naso-tracheal tubes in patients who receive mechanically assisted ventilation, the use of noninvasive ventilation to reduce the need for and duration of endotracheal intubation, changing the breathing circuits of ventilators when they malfunction or are visibly contaminated, and (when feasible) the use of an endotracheal tube with a dorsal lumen to allow drainage of respiratory secretions.“

Schlüsselwörter

Prävention - nosokomial - Pneumonie - Leitlinien

Key words

Prevention - health-care-associated pneumonia - guidelines

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