intensiv 2007; 15(2): 70-77
DOI: 10.1055/s-2007-962988
Intensivpflege

© Georg Thieme Verlag KG Stuttgart · New York

Ventilatorassoziierte Pneumonien und aktive Atemgaskonditionierung: Gibt es einen gesicherten Zusammenhang?

Norbert Schwabbauer1 , Reimer Riessen1
  • 1Intensivstation 3 IS, Medizinische Klinik und Poliklinik der Universität Tübingen
Further Information

Publication History

Publication Date:
26 April 2007 (online)

Zusammenfassung

Die aktive Atemgaskonditionierung steht bei vielen Anwendern in Verdacht, das Auftreten ventilatorassoziierter Pneumonien (VAP) zu begünstigen. Die Untersuchungen zu diesem Thema haben allerdings keinen eindeutigen Vorteil für die passiven Befeuchter gezeigt. Der Vergleich der sehr unterschiedlichen Studien wird durch den differenten Aufbau, die verschiedenen Gerätschaften und deren Einstellung erschwert. Trotzdem hoffen zahlreiche Intensivstationen durch den Einsatz von ausschließlich passiven Befeuchtern einen deutlichen Rückgang der VAP zu erreichen. Oftmals übersehen werden dabei jedoch negative Eigenschaften bzw. Kontraindikationen der auf den ersten Blick einfachen und kostengünstigeren passiven Befeuchtern.

Literatur

  • 1 Safdar. et al . Clinical and economic consequences of ventilator-associated pneumonia: A systematic review.  Crit Care Med. 2005;  33 2184-2193
  • 2 Lellouche. et al . Under-humidification and over-humidification during moderate induced hypothermia with usual devices.  Intensive Care Med. 2006;  32 (7) 1014-1021
  • 3 Prin. et al . Ability and safety of a heated humidifier to control hypercapnic acidosis in severe ARDS.  Intensive Care Med. 2002;  28 1756-1760
  • 4 Prat. et al . Influence of the humidification device during acute respiratory distress syndrome.  Intensive Care Med. 2003;  29 2211-2215
  • 5 Morán. et al . Heat and moisture exchangers and heated humidifiers in acute lung injury/acute respiratory distress syndrome patients. Effects on respiratory mechanics and gas exchange.  Intensive Care Med. 2006;  32 524-531
  • 6 Hinkson. et al . The effects of apparatus dead space on PaCO2 in patients receiving lung-protective ventilation.  Respir Care. 2006;  51 (10) 1140-1144
  • 7 Schwabbauer. HME versus Aktivbefeuchtung: die unendliche Kontroverse.  Intensiv. 2004;  12 106-110
  • 8 Lellouche. et al . Effect of the humidification device on the work of breathing during noninvasive ventilation.  Intensive Care Med. 2002;  28 1582-1589
  • 9 Jaber. et al . Comparison of the effects of heat and moisture exchangers and heated humidifiers on ventilation and gas exchange during non-invasive ventilation.  Intensive Care Med. 2002;  28 1590-1594
  • 10 Girault. et al . Mechanical effects of airway humidification devices in difficult to wean patients.  Crit Care Med. 2003;  31 1306-1311
  • 11 Hilbert. Difficult to wean chronic obstructive pulmonary disease patients: Avoid heat and moisture exchangers?.  Crit Care Med. 2003;  5 (31) 1580-1581
  • 12 Pankin, Trautmann. Was gilt als gesichert in der Prävention der beatmungsassoziierten Pneumonie? Epidemiologie, Risikofaktoren und Erregerspektrum.  Intensiv. 2004;  12 217-228
  • 13 Mattner. et al . Empfehlungen zur Prävention nosokomialer Pneumonien….  Anästhesiol Intensivmed Notfallmed Schmerzther. 2005;  40 79-84
  • 14 Shaw. Ventilator-associated pneumonia.  Current Opinion in Pulmonary Medicin. 2005;  11 236-241
  • 15 Rello. et al . Epidemiology and outcomes of ventilator-associated pneumonia in a large US database.  Chest. 2002;  122 2115-2121
  • 16 Kollef. The prevention of ventilator-associated pneumonia.  N Engl J Med. 1999;  340 (8) 627-634
  • 17 Hess. Noninvasive positive-pressure ventilation and ventilator-associated pneumonia.  Respir Care. 2005;  50 (7) 924-929
  • 18 MacIntyre. Ventilator-associated pneumonia: The role of ventilator management strategies.  Respir Care. 2005;  50 (6) 766-772
  • 19 Chastre J, Fagon J. Ventilator associated Pneumonia, state of the art.  Am J Respir Crit Care Med. 2002;  165 867-903
  • 20 Nseir. et al . Impact of ventilator-associated pneumonia on outcome in patients with COPD.  Chest. 2005;  128 1650-1656
  • 21 Bercault. et al . Intrahospital transport of critically ill ventilated patients: A risk factor for ventilator-associated pneumonia - A matched cohort study.  Crit Care Med. 2005;  33 2471-2478
  • 22 Craven. et al . Contamination of mechanical ventilators with tubing changes every 24 or 48 hours.  N Engl J Med. 1982;  306 (25) 1505-1509
  • 23 Martin. et al . Heat and moisture exchangers and vaporizing humidifiers in the intensive care unit.  Chest. 1990;  97 144
  • 24 Roustan. et al . Comparison of hydrophobic heat and moisture exchangers with heated humidifier during prolonged mechanical ventilation.  Intensive Care Med. 1992;  18 97
  • 25 Dreyfuss. et al . Mechanical ventilation with heated humidifiers or heat and moisture exchangers: effects on patients colonisation and incidence of nosocomial pneumonia.  Am J Respir Crit Care Med. 1995;  151 986-992
  • 26 Branson. et al . Comparison of three humidification techniques during mechanical ventilation: patient selection, cost, and infection considerations.  Respir Care. 1996;  41 (9) 809-816
  • 27 Kirton. et al . A prospective, randomized comparison of an in-lineheat moisture exchange filter and heated wire humidifiers.  Chest. 1997;  112 1055-1059
  • 28 Garner. et al . CDC definitions for nosocomial infections 1988.  Am J Infect Dis. 1988;  16 128-140
  • 29 Ricard. et al .Effect of humidification on the incidence of VAP. Branson, McIntyre Respiratory Care Clinics of North America 2006 12: 263-273
  • 30 Boots. et al . Clinical utility of hygroscopic heat and moisture exchangers in intensive care patients.  Crit Care Med. 1997;  25 (10) 1707-1712
  • 31 Kollef. et al . A randomized clinical trial comparing an extended-use hygroscopic condenser humidifier with heatedwater humidification in mechanically ventilated patients.  Chest. 1998;  113 759
  • 32 Memish. et al . A randomized clinical trial to compare the effects of a heat and moisture exchanger with a heated humidifying system on the occurrence rate of ventilator-associated pneumonia.  Am J Infect Control. 2001;  29 301-305
  • 33 Lacherade. et al . Clinical utility of hygroscopic heat and moisture exchangers in intensive care patients.  Am J Respir Crit Care Med. 2005;  25 (10) 1707-1712
  • 34 Boots. et al . Double-heater-wire circuits and heat-and-moisture exchangers and the risk of ventilator-associated pneumonia.  Crit Care Med. 2006;  34 (3) 687-693
  • 35 Lorente. et al . Ventilator-associated pneumonia using a heated humidifier or a heat and moisture exchanger - a randomized controlled trial.  Critical Care. 2006;  10 R116
  • 36 Kola. et al . Efficacy of heat and moisture exchangers in preventing ventilator-associated pneumonia: meta-analysis of randomized controlled trials.  Intensive Care Med. 2005;  31 5-11
  • 37 Robert-Koch-Institut. Prävention der nosokomialen Pneumonie.  Bundesgesundheitsbl-Gesundheitsforsch-Gesundheitsschutz. 2000;  43 302-309
  • 38 Tablan. et al .Guidelines for Preventing Health-Care-Associated Pneumonia, 2003. Recommendations of the CDC and the Healthcare Infection Control Practices Advisory Committee. Recomm Rep 53,1 MMWR 2004
  • 39 Dodek. et al . Evidence-Based Clinical Practice Guideline for the Prevention of Ventilator-Associated Pneumonia.  Ann Intern Med. 2004;  141 305-313
  • 40 ATS/IDSA Guidelines . Guidelines for the management of adults with HAP, VAP, and HCAP.  Am J Respir Crit Care Med. 2005;  171 388
  • 41 Ricard. Humidification. Tobin Principles and practice of mechanical ventilation New York; McGraw-Hill 2006

Norbert Schwabbauer

Intensivstation 3 IS, Medizinische Klinik und Poliklinik der Universität Tübingen

Otfried-Müller-Straße 10

72076 Tübingen

Email: Norbert.Schwabbauer@Med.Uni-Tuebingen.de

    >