Das pulmonale Negativdrucködem

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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