Protektive Beatmung reduziert postoperative pulmonale Komplikationen – Pro

Zusammenfassung

Postoperative pulmonale Komplikationen tragen in relevantem Ausmaß zur Erhöhung von Morbidität und Mortalität nach chirurgischen Eingriffen bei, deren Risiko durch eine intraoperative protektive Beatmung reduziert werden kann. Demnach reduziert die Anwendung niedriger Tidalvolumina während der intraoperativen Beatmung die Rate an postoperativen pulmonalen Komplikationen. Obwohl die Applikation von positivem end-exspiratorischem Druck (PEEP) und die Anwendung von Lungenrekrutierungsmanövern die Lungenfunktion intraoperativ verbessern, können diese eine Kreislaufinstabilität hervorgerufen. Bei Patienten, welche sich offenen abdominal chirurgischen Eingriffen unterziehen und keine Lungenschädigung sowie Fettleiblichkeit aufweisen, schützen PEEP und Lungenrekrutierungsmanöver nicht gegen postoperativen pulmonalen Komplikationen. Noch ist es unklar, ob die Anwendung von intraoperativem PEEP bei anderen Patientenpopulationen und chirurgischen Interventionen, wie z.B. Adipositas bzw. Thoraxeingriffen , für die Lungenprotektion relevant ist.

Summary

Postoperative pulmonary complications add to higher mortality and morbidity. This risk could be lowered with intraoperative protective ventilation, especially with low tidal volumes. The application of PEEP and the use of recruitement maneuvers can enhance the lung function during surgery, but can also cause haemodynamic instability. In patients with open abdominal surgery and no lung damage or obesity, PEEP and recruitement maneuvers have no protective effect against postoperative pulmonary complications. It is still unclear, wether the use of intraoperative PEEP in other patient groups and during different surgery procedures is relevant for lung protection.

Schlüsselwörter:

Intraoperative Beatmung - beatmungsinduzierte Lungenschädigung - postoperative pulmonale Komplikationen

Keywords:

Intraoperative mechanical ventilation - ventilator induced lung injury - postoperative pulmonary complications

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