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Anästhesiol Intensivmed Notfallmed Schmerzther 2015; 50(9): 524-528
DOI: 10.1055/s-0041-103880
Fachwissen
Anästhesiologie
© Georg Thieme Verlag Stuttgart · New York

Protektive Beatmung reduziert postoperative pulmonale Komplikationen – Pro

Intraoperative protective ventilation reduces postoperative pulmonary complications – PRO
Andreas Güldner
,
Marcelo Gama de Abreu
Further Information

Publication History

Publication Date:
16 September 2015 (online)

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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.

Kernaussagen

  • Postoperative pulmonale Komplikationen tragen in relevantem Ausmaß zur Erhöhung von Morbidität und Mortalität nach chirurgischen Eingriffen bei. Deren Reduktion ist somit ein wichtiges Ziel in der perioperativen Medizin.

  • Auch die intraoperative Beatmung kann mit einer beatmungsinduzierten Lungenschädigung zur Entstehung postoperativer pulmonaler Komplikationen beitragen.

  • Die intraoperative protektive Beatmung senkt das Risiko für postoperative pulmonale Komplikationen, besonders die Applikation niedriger Vt ist dabei entscheidend.

  • Die Anwendung von PEEP und / oder Rekrutierungsmanövern trägt zwar zu einer Optimierung der Lungenfunktion bei, kann jedoch zumindest bei normalgewichtigen Patienten, die sich einem offenen abdominalchirurgischen Eingriff unterziehen, die Rate an postoperativen pulmonalen Komplikationen nicht verringern.

  • Ob bei adipösen Patienten und / oder während laparoskopischen oder Eingriffen unter Einlungenventilation durch PEEP und / oder Rekrutierungsmanöver das klinische Outcome verbessert werden kann, müssen weitere Untersuchungen zeigen.

Schlüsselwörter:

Intraoperative Beatmung - beatmungsinduzierte Lungenschädigung - postoperative pulmonale Komplikationen

Keywords:

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

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