PNEUMOLOGE最新文献

The pandemic and the spread of multidrug-resistant pathogens impressively demonstrate that despite all medical and technical progress, infectious diseases still represent a global threat. The occurrence of new or difficult to treat infections due to resistance is determined by the dynamic evolution of pathogens, which can often have an erratic course and is not easily predictable. Coronavirus disease 2019 (COVID-19) has improved the understanding of airway infections and in addition to strategies targeted against the pathogen, has again demonstrated the importance of immunomodulation. Pathogen sequencing, point of care testing and decision aids based on artificial intelligence are some of the innovative techniques which will improve the management of airway infections in the coming years. In addition to viral airway infections, bacterial carbapenem-resistant pathogens (CRE) increasingly represent a therapeutic barrier in cases of nosocomial pneumonia. In recent years approval was given to beta lactams that are effective against CRE; however, their effectiveness is dependent on the underlying mechanism of resistance to carbapenem. An extended 20-valent pneumococcal conjugate vaccine will become available in 2022 for adults. A high-dose vaccine against influenza has been in use since 2021 for older adults. This article provides a highlighted overview of selected significant innovations in recent years in the field of airway infections.

High-flow oxygen therapy (high flow nasal cannula, HFNC), in which an oxygen-air gas mixture is applied at flow rates between 30 and 70 L/min, is a technically simple and highly effective procedure for the treatment of hypoxemic respiratory insufficiency. Furthermore, HFNC can be used during bronchoscopy for oxygenation, before intubation for preoxygenation, and after extubation to avoid reintubation. The high gas flow prevents the patient from inspiring ambient air, allowing precise adjustment of an inspiratory oxygen fraction; furthermore, a positive end-expiratory pressure is built up by a resulting dynamic pressure, mucociliary clearance is improved by humidification and warming of the air breathed and the work of breathing is reduced by flushing the upper airways. Compared with conventional oxygen therapy, aerosol formation is not increased by HFNC; therefore, this procedure can also be used for patients with coronavirus disease 2019 (COVID-19). In hypercapnic respiratory failure the data are inconclusive and in this case noninvasive ventilation should currently be preferred instead of HFNC. It is important to remember that patients treated with HFNC are critically ill and therefore require continuous monitoring. It must be ensured that an escalation of therapy, e.g. to intubation and invasive ventilation, can be performed at any time.

Pulmonary rehabilitation (PR) is an evidence-based multidisciplinary treatment for patients with chronic respiratory diseases. The indications for PR prescription are given if there is a rehabilitation capability, a need for rehabilitation and a beneficial rehabilitation prognosis. The aims of PR are to reduce symptoms and to improve the quality of life and the patients' physical capacity. The effectiveness of PR is well-proven for patients with chronic obstructive pulmonary disease (COPD) at the highest level of evidence and for non-COPD patients with an increasing level of evidence based on randomized controlled trials and meta-analyses. The treatment content of PR is individually adapted to the patients' needs by a multimodal and multidisciplinary treatment team. To maintain the rehabilitation benefits of PR there is the possibility to participate in outpatient follow-up programs as well as to use digital technologies.

The use of inhaled psychotropic substances is widespread in our society. In addition to the wide variety of tobacco-containing smoking products, e‑cigarettes, cannabis, sniffing substances, cocaine and heroin are consumed by inhalation. While the harmful effects of most tobacco-containing smoking products on the lungs have been sufficiently researched, there is still a lack of scientifically sound evidence for many other substances consumed by inhalation. In particular, for novel products, such as e‑cigarettes and tobacco heaters, there is a lack of independent standardized data demonstrating reduced health risk as a result of lower exposure to harmful substances. Clear conclusions are also currently not possible for the long-term effects of cannabis use on the lungs and respiratory tract. For the inhaled use of cocaine and heroin, on the other hand, considerable damage to the lungs can be documented, especially in the case of extensive and chronic use.