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Anästhesiol Intensivmed Notfallmed Schmerzther 2005; 40(2): 79-84
DOI: 10.1055/s-2004-825929
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Empfehlungen zur Prävention nosokomialer Pneumonien

nach den „Guidelines for Preventing Health-Care-Associated Pneumonia, 2003”, Recommendations of CDC (Centers of Disease Control and Prevention) and HICPAC (Healthcare Infection Control Practices Advisory Committee) [1] Guidelines for Preventing Health-Care-Associated PneumoniaF.  Mattner1 , P.  Gastmeier1
  • 1 Medizinische Hochschule Hannover
Further Information

Publication History

Publication Date:
16 February 2005 (online)

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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

Literatur

  • 1 http://www.cdc.gov/ncidod/hip/guide/CDCpneumo_guidelines.pdf. 
    Google Scholar
  • 2 Ruden H, Gastmeier P, Daschner F D, Schumacher M. Nosocomial and community-acquired infections in Germany. Summary of the results of the First National Prevalence Study (NIDEP).  Infection. 1997;  25 199-202
    CrossrefPubMedGoogle Scholar
  • 3 http://www.medizin.fu-berlin.de/hygiene/download/referenzdaten.htm. 2002. 
    Google Scholar
  • 4 Fagon J Y, Chastre J, Hance A J, Montravers P, Novara A, Gibert C. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay.  Am J Med. 1993;  94 281-288
    CrossrefPubMedGoogle Scholar
  • 5 Heyland D K, Cook D J, Griffith L, Keenan S P, Brun-Buisson C. The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. The Canadian Critical Trials Group.  Am J Respir Crit Care Med. 1999;  159 1249-1256
    CrossrefPubMedGoogle Scholar
  • 6 Bercault N, Boulain T. Mortality rate attributable to ventilator-associated nosocomial pneumonia in an adult intensive care unit: a prospective case-control study.  Crit Care Med. 2001;  29 2303-2309
    PubMedGoogle Scholar
  • 7 Moine P, Timsit J F, De Lassence A, Troche G, Fosse J P, Alberti C, Cohen Y. Mortality associated with late-onset pneumonia in the intensive care unit: results of a multi-center cohort study.  Intensive Care Med. 2002;  28 154-163
    CrossrefPubMedGoogle Scholar
  • 8 Warren D K, Shukla S J, Olsen M A, Kollef M H, Hollenbeak C S, Cox M J, Cohen M M, Fraser V J. Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center.  Crit Care Med. 2003;  31 1312-1317
    CrossrefPubMedGoogle Scholar
  • 9 Rosenthal V D, Guzman S, Orellano P W. Nosocomial infections in medical-surgical intensive care units in Argentina: attributable mortality and length of stay.  Am J Infect Control. 2003;  31 291-295
    CrossrefPubMedGoogle Scholar
  • 10 Erbay H R, Yalcin N A, Zencir M, Serin S, Atalay H. Costs and risk factors for ventilator-associated pneumonia in a Turkish University Hospital’s Intensive Care Unit: A case-control study.  BMC Pulm Med. 2004;  4 3
    CrossrefPubMedGoogle Scholar
  • 11 Rello J, Ollendorf D A, Oster G, Vera-Llonch M, Bellm L, Redman R, Kollef M H. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database.  Chest. 2002;  122 2115-2121
    CrossrefPubMedGoogle Scholar
  • 12 Schulgen G, Kropec A, Kappstein I, Daschner F, Schumacher M. Estimation of extra hospital stay attributable to nosocomial infections: heterogeneity and timing of events.  J Clin Epidemiol. 2000;  53 409-417
    CrossrefPubMedGoogle Scholar
  • 13 http://www.cdc.gov/ncidod/hip/NNIS/members/pneumonia/Criteria.PDF. 
    Google Scholar
  • 14 Horan T C, Gaynes R P, Mayhall C G. Surveillance of nosocomial infections; Hospital epidemiology and infection control. Lippincott Williams and Wilkons 2004: 1687-1689
    Google Scholar
  • 15 Zack J E, Garrison T, Trovillion E, Clinkscale D, Coopersmith C M, Fraser V J, Kollef M H. Effect of an education program aimed at reducing the occurrence of ventilator-associated pneumonia.  Crit Care Med. 2002;  30 2407-2412
    CrossrefPubMedGoogle Scholar
  • 16 Gastmeier P, Beck K D, Lach H. Beatmungsfilter und Pneumonie in der Intensivmedizin.  DMW. 2001;  126 835-838
    PubMedGoogle Scholar
  • 17 Pegues C F, Pegues D A, Ford D S, Hibberd P L, Carson L A, Raine C M, Hooper D C. Burkholderia cepacia respiratory tract acquisition: epidemiology and molecular characterization of a large nosocomial outbreak.  Epidemiol Infect. 1996;  116 309-317
    CrossrefPubMedGoogle Scholar
  • 18 http://www.rki.de/INFEKT/EPIBULL/2003/32_03.PDF. 
    Google Scholar
  • 19 Mahul P, Auboyer C, Jospe R, Ros A, Guerin C, el Khouri Z, Galliez M, Dumont A, Gaudin O. Prevention of nosocomial pneumonia in intubated patients: respective role of mechanical subglottic secretions drainage and stress ulcer prophylaxis.  Intensive Care Med. 1992;  18 20-25
    CrossrefPubMedGoogle Scholar
  • 20 Kollef M H, Skubas N J, Sundt T M. A randomized clinical trial of continuous aspiration of subglottic secretions in cardiac surgery patients.  Chest. 1999;  116 1339-1346
    PubMedGoogle Scholar
  • 21 Smulders K, van der Hoeven H, Weers-Pothoff I, Vandenbroucke-Grauls C. A randomized clinical trial of intermittent subglottic secretion drainage in patients receiving mechanical ventilation.  Chest. 2002;  121 858-862
    CrossrefPubMedGoogle Scholar
  • 22 Valles J, Artigas A, Rello J, Bonsoms N, Fontanals D, Blanch L, Fernandez R, Baigorri F, Mestre J. Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia.  Ann Intern Med. 1995;  122 179-186
    PubMedGoogle Scholar
  • 23 Shorr A F, O’Malley P G. Continuous subglottic suctioning for the prevention of ventilator-associated pneumonia: potential economic implications.  Chest. 2001;  119 228-235
    CrossrefPubMedGoogle Scholar
  • 24 Drakulovic M B, Torres A, Bauer T T, Nicolas J M, Nogue S, Ferrer M. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial.  Lancet. 1999;  354 1851-1858
    CrossrefPubMedGoogle Scholar
  • 25 Dear K, Holden J, Andrews R, Tatham D. Vaccines for preventing pneumococcal infection in adults. Cochrane Database Syst Rev 2003: CD000422
    Google Scholar
  • 26 Cook D, De Jonghe B, Brochard L, Brun-Buisson C. Influence of airway management on ventilator-associated pneumonia: evidence from randomized trials.  Jama. 1998;  279 781-787
    CrossrefPubMedGoogle Scholar
  • 27 Holzapfel L, Chevret S, Madinier G, Ohen F, Demingeon G, Coupry A, Chaudet M. Influence of long-term oro- or nasotracheal intubation on nosocomial maxillary sinusitis and pneumonia: results of a prospective, randomized, clinical trial.  Crit Care Med. 1993;  21 1132-1138
    CrossrefPubMedGoogle Scholar
  • 28 DeRiso A J 2nd, Ladowski J S, Dillon T A, Justice J W, Peterson A C. Chlorhexidine gluconate 0.12 % oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery.  Chest. 1996;  109 1556-1561
    PubMedGoogle Scholar

Frauke Mattner

Medizinische Hochschule Hannover · Medizinische Mikrobiologie und Krankenhaushygiene

Carl-Neuberg-Straße 1 · 30625 Hannover

Email: Mattner.Frauke@mh-hannover.de

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