Pneumonien durch schleichende Aspiration – eine diagnostische und therapeutische Herausforderung

Zusammenfassung

Formen der akuten Aspirationspneumonie (AP) umfassen die Aspiration größerer Mengen dem Magen zugeführter Substanzen und die im Rahmen einer schleichenden Aspiration oropharyngealen Sekrets entstehenden Pneumonien.
Schleichenden Aspirationen liegt eine Dysphagie, ggf. zusammen mit einem eingeschränkten Hustenreflex, zugrunde. Ein hohes Lebensalter, häufig zusammen mit schwerer Komorbidität und eingeschränkter Funktionalität begünstigen die Entstehung von Aspirationspneumonien.
Daher ist die schleichende Aspiration eine häufige Ursache der ambulant erworbenen Pneumonie des Menschen in höherem Lebensalter, ebenso aber auch der nosokomialen Pneumonie. An eine AP ist darüber hinaus immer bei rezidivierenden Pneumonien zu denken.
Zur Akutbehandlung gehören über die antimikrobielle Therapie hinaus eine Atem- und eine Physiotherapie. Zudem sollten alle Patienten mit schleichender Aspiration bzw. AP einer Schluckuntersuchung und bei bestehender Dysphagie auch einer Schlucktherapie zugeführt werden. Diese kann im Rahmen einer logopädischen Therapie restituierende, kompensatorische und adaptierende Verfahren einschließen.

Abstract

Aspiration pneumonia (AP) may present as gross aspiration of large gastric contents or as a consequence of silent aspiration of contaminated oropharyngeal secretions.
AP due to silent aspiration is caused by dysphagia and, in some instances, impaired cough reflex. Factors favouring the development of pneumonia include advanced age as well as severe comorbidity and impaired functional status.
Therefore, silent aspiration is a frequent etiology of community-acquired pneumonia in aged patients but also of nosocomial pneumonia. Recurrent pneumonia should always prompt the consideration of AP.
Treatment of acute AP should include not only the use of antimicrobial agents but also chest physiotherapy and airway clearance techniques. In addition, all patients with silent aspiration and AP should be subject to an investigation of swallowing function and, in the presence of dysphagia, also receive treatment for this condition. This includes methods of restitution, compensation and adaptation of impaired swallowing function.

Schlüsselwörter

Aspiration - Dysphagie - Schluckfunktion - Schluckdiagnostik - Schlucktherapie

Keywords

aspiration - dysphagia - swallowing function - swallowing investigation - swallowing treatment

Publikationsverlauf

Eingereicht: 07. September 2024

Angenommen nach Revision: 20. November 2024

Artikel online veröffentlicht:
13. Dezember 2024

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