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Aspirationssyndrom

Epidemiologie, Pathophysiologie und Therapie

Aspiration syndrome

Epidemiology, pathophysiology, and therapy

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Zusammenfassung

Die Aspiration fester oder flüssiger Materialien perioperativ ist eine seltene, aber schwerwiegende Komplikation, die zum akuten Lungenversagen führen kann. Zur Risikostratifizierung und Vermeidung hilft die Kenntnis der prädisponierenden Risikofaktoren und Krankheiten. Die Narkoseeinleitung bei potenziell nicht nüchternen Patienten erfolgt als „rapid sequence induction“ (RSI). Bei beobachteter Aspiration ist schnelles und umsichtiges Handeln wichtig. Ein vorbereiteter Arbeitsplatz und ein geschultes Team können den Schaden minimieren. Kenntnisse der Pathophysiologie und Mikrobiologie bei Aspiration sind Voraussetzungen für die richtige Therapie. Eine perioperative Aspiration impliziert eine verlängerte Beobachtung mit respiratorischem Monitoring des Patienten im Aufwachraum oder auf der Intensivstation. Die Behandlung der Pneumonitis ist supportiv, während bei Pneumonie zusätzlich eine antiinfektive Therapie erforderlich ist, die sich an den Risikofaktoren des Patienten, den Umständen der Aspiration und dem zu erwartenden Keimspektrum orientiert.

Abstract

Aspiration syndromes are important causes of morbidity and mortality during general anaesthesia as well as in the intensive care unit. Up to 30% of patients with aspiration may develop an acute respiratory distress syndrome, with an attributed mortality of 16%. Although aspiration syndrome is not a frequent event, the anaesthesist must be familiar with the management of this complication and must know the risk factors for it. Discrimination between pneumonitis, an abacterial inflammation, and pneumonia is of utmost importance because treatment strategies differ; for instance, treatment is merely supportive in pneumonitis. This review gives an overview of the epidemiology and pathophysiology of aspiration syndrome, strategies to avoid aspiration, and a brief discussion of treatment concepts.

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  1. Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland

    O. Bartusch, M. Finkl & U. Jaschinski

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  1. O. Bartusch
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  2. M. Finkl
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  3. U. Jaschinski
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Correspondence to U. Jaschinski.

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Bartusch, O., Finkl, M. & Jaschinski, U. Aspirationssyndrom. Anaesthesist 57, 519–532 (2008). https://doi.org/10.1007/s00101-008-1348-4

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