Septisches Lungenversagen

摘要

Septic pulmonary failure is associated with a high mortality rate, and this has not changed over the last several years. The causes are primary pulmonary infections as well as secondary inflammatory reaction of the lung due to extrapulmonary septic foci. Ventilator-associated lung injury can also worsen septic pulmonary failure. Besides the causal treatment of sepsis, several measures are available in the management of septic pulmonary failure, which extend from fluid restriction, prone positioning to protective ventilation. Protective ventilation consists of low tidal volume, permissive hypercapnia, inspiratory plateau pressure lower than 30 cm H₂O and high PEEP. A central problem regarding mechanical ventilation is tailoring the tidal volume to the compliance of the injured lung. A tidal volume of 6 ml/kg ideal body weight is certainly better than 12 ml/kg; however, this is not the optimum to prevent ventilator- associated lung injury in patients with severe septic pulmonary failure. Extracorporeal lung assist or high frequency oscillation are helpful for effective carbon dioxide elimination if a severe respiratory acidosis ensues as a result of decreasing tidal volume. In case of persistent life-threatening hypoxia, alveolar recruitment maneuvers and extracorporeal membrane oxygenation can be applied. Further adjuvant measures should be considered in individual cases. Weaning from respirator can be delayed as a result of critical illness polyneuropathy and/or myopathy.