Beatmung bei Sepsis – Standards und Innovationen

Der modernen lungenprotektiven Beatmungstherapie im Rahmen der Sepsis kommt eine entscheidende Rolle für die intensivmedizinische Behandlung schwerstkranker Patienten zu. In Studien konnte gezeigt werden, dass eine lungenprotektive Beatmungsstrategie eine Reduktion der Mortalität und Morbidität in allen Patientengruppen bewirkt. Im Gegenzug konnte in experimentellen und klinischen Studien ein starker Einfluss nicht-protektiver Beatmungsstrategien (Volutrauma, Atelektrauma) auf die Freisetzung inflammatorischer Zytokine in die systemische Zirkulation mit entsprechender Morbidität und Mortalität nachgewiesen werden (Biotrauma). Ziel einer lungenprotektiven Beatmung im Rahmen der Sepsis ist es daher, die negativen Folgen mechanischer Beatmung im Sinne eines ventilator-induzierten Lungenschadens (VILI) und eines Multiorganversagens (MOF) zu verhindern.

Wir stellen in dieser Übersicht pathophysiologische Konzepte und Konsequenzen beatmungsinduzierter Lungenschädigung und etablierte Verfahren und Innovationen der lungenprotektiven Beatmung bei Sepsis vor.

Modern lung-protective mechanical ventilation during sepsis holds a pivotal role during intensive medical care of severely ill patients.

Scientific studies have demonstrated a reduction of mortality and morbidity by application of lung protective ventilation strategies across all patient groups. On the other hand, it has clearly been shown both in experimental and clinical studies that non-protective ventilatory settings (volutrauma, atelectrauma) result in the release of inflammatory cytokines into the systemic circulation (biotrauma) with resultant morbidity and mortality. Lung-protective ventilation during sepsis allows a reduction of the negative implications of mechanical ventilation including ventilator-induced lung injury (VILI) and multiple organ failure (MOF). In this article, we review the pathophysiology and consequences of ventilator induced lung injury and present established and emerging innovative concepts of lung-protective ventilation during sepsis.

Key words

Lung-protective ventilation - atelectrauma - volutrauma - biotrauma - sepsis

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