Pneumonien in der neurologischen Intensivmedizin

Abstract

Patients on specialized neurological intensive care units carry an increased risk for the development of lung infections. This increased risk is partly attributable to the underlying neurological disease. Ventilator associated pneumonias play an important role in this context. Specialized neurointensive care aims at optimizing patient management by means of appropriate prophylaxis, diagnostics, and therapy, taking also into account important neurological factors. Strict application of evidence-based guidelines is essential for reducing mortality, duration of intensive care treatment, and associated costs of pneumonia. A sufficient primary antibiotic therapy warrants an analysis of a patient's risk to be infected by a drug-multiresistent infectious agent. Application of standard therapy regimes without consideration of patient-specific factors should be avoided as it increases the risk of inadequate therapy and worsening of prognosis. Every intensive care unit should take into account the local distribution of bacteria and resistance patterns when choosing the appropriate antibiotic therapy. This review focuses on up to date recommendations for prophylaxis, diagnostics, and therapy of bacterial lung infection in neurocritical care. Community acquired pneumonias and lung infection in immunocompromised patients will also be briefly discussed.