Zusammenfassung
Das pulmonale Negativdrucködem („negative-pressure pulmonary edema” [NPPE]) ist ein
anästhesiologisch relevantes Krankheitsbild, das in der perioperativen Phase infolge
einer Einengung des konduktiven Luftweges entsteht und in ∼ 50 % der Fälle durch einen
Laryngospasmus bedingt ist. Aufgrund seiner Akuität bedarf es sofortiger Diagnose
und Therapie durch den Anästhesisten. Das NPPE, auch Postobstruktionslungenödem genannt,
ist in der Mehrzahl der Fälle gekennzeichnet durch einen raschen, innerhalb von wenigen
Minuten auftretenden Symptomenkomplex („rapid onset”) und imponiert vor allem durch
eine respiratorische Insuffizienz mit Dyspnoe, Tachypnoe und angestrengten Inspirationsbemühungen.
Zusätzlich können paradoxe Atmung, rötlich-schaumiges Trachealsekret, Stridor und
Agitation des Patienten hinzutreten. Pathophysiologisch bewirkt diese Atemwegsobstruktion
beim spontan atmenden Menschen während der Inspiration einen extrem negativen intrathorakalen
Druck, der konsekutiv eine akute Erhöhung des rechtsventrikulären venösen Rückstroms
verursacht und dadurch das intrapulmonale Blutvolumen steigert. Auf diese Weise kommt
es zu einer Erhöhung des hydrostatischen Drucks mit Transsudation von Flüssigkeit
in das pulmonale Interstitium. In der medizinischen Literatur werden Epidemiologie
und Prävalenz des pulmonalen Negativdrucködems kontrovers beurteilt, hauptsächlich
ist dies in der unterschiedlichen Verwendung der Diagnosekriterien des NPPE begründet.
So konnte gezeigt werden, dass nicht nur Patienten, die intubiert und beatmet wurden
ein Negativdrucködem der Lunge entwickelten, sondern auch postOP-Patienten mit erhöhtem
und prolongiertem Bedarf an Sauerstoff.
Abstract
Negative-pressure pulmonary edema (NPPE) is a clinical entity of anaesthesiologic
relevance, perioperatively caused by obstruction of the conductive airways (upper
airway obstruction, UAO) due to laryngospasm in approx. 50 % of the cases, its early
recognition and treatment by the anaesthesist is mandatory. NPPE, also addressed as
post-obstructive pulmonary edema (POPE) presents in most cases as a complex of symptoms
with rapid onset, consisting of acute respiratory failure with dyspnea, tachypnea,
and strained respiratory efforts. Additional signs are paradoxe ventilation, pink
frothy sputum, stridor, and severe agitation. UAO produce extreme reduction of intrathoracic
pressure during spontaneous ventilation, consecutively causing increase in venous
return to the right ventricle and in intrathoracic blood volume, resulting in elevated
hydrostatic pressures and interstitial transsudation of fluids. Partially due to largely
differing criteria used for diagnosis, opinions about incidence and prevalence of
NPPE are unhomogenous in medical literature. It has been shown that generation of
NPPE is not only limited to patients being intubated and ventilated, but occurs also
in patients requiring higher fractions of oxygen.
Schlüsselwörter
NPPE, Postobstruktionslungenödem - nicht-kardiales Niedrigdrucködem
Key words
NPPE, negative-pressure pulmonary edema - POPE, post-obstructive pulmonary edema -
non-cardial low pressure edema
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Dr. med. Markus Alb
Klinik für Anästhesiologie und Operative Intensivmedizin · Universitätsklinikum Mannheim
Theodor-Kutzer-Ufer 1 - 3 · 68167 Mannheim
Email: markus.alb@anaes.ma.uni-heidelberg.de