Skip to main content

Tipp

Weitere Artikel dieser Ausgabe durch Wischen aufrufen

Erschienen in: Wiener klinisches Magazin 1/2019

10.01.2019 | Innere Medizin | Anästhesie & Intensivmedizin

Delir beim Intensivpatienten

Eine multiprofessionelle Herausforderung

verfasst von: Priv.-Doz. Dr. Norbert Zoremba, Ph.D., Prof. Dr. Marc Coburn, Priv.-Doz. Dr. Gereon Schälte

Erschienen in: Wiener klinisches Magazin | Ausgabe 1/2019

Einloggen, um Zugang zu erhalten

Zusammenfassung

Delir ist die häufigste Form einer zerebralen Dysfunktion bei Patienten auf der Intensivstation und ein medizinischer Notfall, der vermieden oder zeitnah diagnostiziert und therapiert werden muss. Nach heutigem Kenntnisstand scheint die Entwicklung eines Delirs durch ein Zusammenspiel von erhöhter Vulnerabilität (Prädisposition) und der gleichzeitigen Exposition gegenüber delirogenen Faktoren bedingt zu sein. Da in der klinischen Routine ein Delir häufig übersehen wird, sollte engmaschig ein Delirscreening erfolgen. Wegen der engen Verknüpfung zwischen Delir, Agitation und Schmerz muss analog zum Delirscreening mindestens alle 8 h zusätzlich eine Evaluation der Sedierung und der Analgesie erfolgen. In der Prävention und Therapie des Delirs wird nach heutigem Kenntnisstand ein multifaktorielles und multiprofessionelles Vorgehen favorisiert. Hierbei hat die nichtmedikamentöse Intervention durch Frühmobilisation, Reorientierung, Schlafverbesserung, adäquate Schmerztherapie und Vermeidung einer Polypharmazie einen hohen Stellenwert. In der symptomorientierten medikamentösen Delirtherapie finden, in Abhängigkeit von dem klinischen Bild, unterschiedliche Substanzen Anwendung. Um diese diagnostischen und therapeutischen Ziele zu erreichen, ist ein interdisziplinäres Behandlungsteam, bestehend aus Intensivpflege, Intensivärzten, Stationsapothekern, Physiotherapeuten, Ernährungsspezialisten und Psychiatern notwendig, um den Anforderungen des Patienten und deren Angehörigen gerecht zu werden.
Literatur
2.
Zurück zum Zitat Ely EW, Inouye SK, Bernard GR et al (2001) Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 286:2703–2710 PubMedCrossRef Ely EW, Inouye SK, Bernard GR et al (2001) Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 286:2703–2710 PubMedCrossRef
3.
Zurück zum Zitat Adamis D, Rooney S, Meagher D et al (2015) A comparison of delirium diagnosis in elderly medical inpatients using the CAM, DRS-R98, DSM-IV and DSM-5 criteria. Int Psychogeriatr 27:883–889 PubMedCrossRef Adamis D, Rooney S, Meagher D et al (2015) A comparison of delirium diagnosis in elderly medical inpatients using the CAM, DRS-R98, DSM-IV and DSM-5 criteria. Int Psychogeriatr 27:883–889 PubMedCrossRef
5.
Zurück zum Zitat Luetz A, Heymann A, Radtke FM et al (2010) Was wir nicht messen, detektieren wir meist auch nicht. AINS 45:106–111 Luetz A, Heymann A, Radtke FM et al (2010) Was wir nicht messen, detektieren wir meist auch nicht. AINS 45:106–111
6.
Zurück zum Zitat S3-Leitlinie (2015) Analgesie, Sedierung und Delirmanagement in der Intensivmedizin. AWMF Register Nr.:001/012 S3-Leitlinie (2015) Analgesie, Sedierung und Delirmanagement in der Intensivmedizin. AWMF Register Nr.:001/012
7.
Zurück zum Zitat Ely EW, Shintani A, Truman B et al (2004) Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 291:1753–1762 PubMedCrossRef Ely EW, Shintani A, Truman B et al (2004) Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 291:1753–1762 PubMedCrossRef
8.
Zurück zum Zitat Pisani MA, Kong SY, Kasl SV et al (2009) Days of delirium are associated with 1‑year mortality in an older intensive care unit population. Am J Respir Crit Care Med 180:1092–1097 PubMedPubMedCentralCrossRef Pisani MA, Kong SY, Kasl SV et al (2009) Days of delirium are associated with 1‑year mortality in an older intensive care unit population. Am J Respir Crit Care Med 180:1092–1097 PubMedPubMedCentralCrossRef
9.
10.
Zurück zum Zitat Levkoff S, Liptzin B, Cleary P et al (1996) Subsyndromal delirium. Am J Geriatr Psychiatry 4:320–329 PubMedCrossRef Levkoff S, Liptzin B, Cleary P et al (1996) Subsyndromal delirium. Am J Geriatr Psychiatry 4:320–329 PubMedCrossRef
11.
Zurück zum Zitat Donovan AL, Aldrich M, Gross AK (2018) Interprofessional care and teamwork in the ICU. Crit Care Med 46:980–990 PubMedCrossRef Donovan AL, Aldrich M, Gross AK (2018) Interprofessional care and teamwork in the ICU. Crit Care Med 46:980–990 PubMedCrossRef
12.
Zurück zum Zitat Jenewein J, Büchi S (2007) Neurobiologische und pathophysiologische Grundlagen des Delirs. Schweiz Arch Neurol Psychiatr 158:360–367 CrossRef Jenewein J, Büchi S (2007) Neurobiologische und pathophysiologische Grundlagen des Delirs. Schweiz Arch Neurol Psychiatr 158:360–367 CrossRef
14.
Zurück zum Zitat Trzepacz PT (2000) Is there a final common neural pathway in delirium? Focus on acetylcholine and dopamine. Semin Clin Neuropsychiatry 5:132–148 PubMed Trzepacz PT (2000) Is there a final common neural pathway in delirium? Focus on acetylcholine and dopamine. Semin Clin Neuropsychiatry 5:132–148 PubMed
15.
Zurück zum Zitat Hilger E, Fischer P (2002) Pathophysiologische Korrelate deliranter Syndrome. J Neurol Neurochir Psychiatr 3:32–40 Hilger E, Fischer P (2002) Pathophysiologische Korrelate deliranter Syndrome. J Neurol Neurochir Psychiatr 3:32–40
16.
Zurück zum Zitat Von Haken R, Gruß M, Plaschke K et al (2010) Delir auf der Intensivstation. Anästhesist 59:235–247 CrossRef Von Haken R, Gruß M, Plaschke K et al (2010) Delir auf der Intensivstation. Anästhesist 59:235–247 CrossRef
17.
Zurück zum Zitat Han , McCusker J, Cole M et al (2001) Use of medications with anticholinergic effect predicts clinical severity of delirium symptoms in older medical inpatients. Arch Intern Med 161:1099–1105 PubMedCrossRef Han , McCusker J, Cole M et al (2001) Use of medications with anticholinergic effect predicts clinical severity of delirium symptoms in older medical inpatients. Arch Intern Med 161:1099–1105 PubMedCrossRef
18.
Zurück zum Zitat Mulsant BH, Pollock BG, Kishner M et al (2003) Serum anticholinergic activity in a community-based sample of older adults: relationship with cognitive performance. Arch Gen Psychiatry 60:198–203 PubMedCrossRef Mulsant BH, Pollock BG, Kishner M et al (2003) Serum anticholinergic activity in a community-based sample of older adults: relationship with cognitive performance. Arch Gen Psychiatry 60:198–203 PubMedCrossRef
19.
Zurück zum Zitat Calabresi P, Picconi B, Parnetti L et al (2006) A convergent model for cognitive dysfunctions in Parkinson’s disease: the critical dopamine-acetylcholine synaptic balance. Lancet Neurol 5:974–983 PubMedCrossRef Calabresi P, Picconi B, Parnetti L et al (2006) A convergent model for cognitive dysfunctions in Parkinson’s disease: the critical dopamine-acetylcholine synaptic balance. Lancet Neurol 5:974–983 PubMedCrossRef
20.
Zurück zum Zitat Van der Mast RC, Fekkes D (2000) serotonin and amino acids: partners in delirium pathophysiology? Semin Clin Neuropsychiatry 5:125–131 PubMed Van der Mast RC, Fekkes D (2000) serotonin and amino acids: partners in delirium pathophysiology? Semin Clin Neuropsychiatry 5:125–131 PubMed
21.
Zurück zum Zitat Pendlebury ST, Lovett NG, Smith SC et al (2015) Observational, longitudinal study of delirium in consecutive unselected acute medical admissions: age-specific rates and associated factors, mortality and re-admission. BMJ Open 5:e7808 PubMedPubMedCentralCrossRef Pendlebury ST, Lovett NG, Smith SC et al (2015) Observational, longitudinal study of delirium in consecutive unselected acute medical admissions: age-specific rates and associated factors, mortality and re-admission. BMJ Open 5:e7808 PubMedPubMedCentralCrossRef
22.
Zurück zum Zitat Pandharipande P, Shintani A, Peterson J et al (2006) Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology 1100:781–787 Pandharipande P, Shintani A, Peterson J et al (2006) Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology 1100:781–787
23.
Zurück zum Zitat Kelly KM, Nadon NL, Morrison JH et al (2006) The neurobiology of aging. Epilepsy Res 68(Suppl.1):5–20 CrossRef Kelly KM, Nadon NL, Morrison JH et al (2006) The neurobiology of aging. Epilepsy Res 68(Suppl.1):5–20 CrossRef
24.
Zurück zum Zitat Inouye S, Zhang Y, Jones R et al (2007) Risk factors for delirium at discharge: development and validation of a predictive model. Arch Intern Med 167:1406–1413 PubMedCrossRef Inouye S, Zhang Y, Jones R et al (2007) Risk factors for delirium at discharge: development and validation of a predictive model. Arch Intern Med 167:1406–1413 PubMedCrossRef
25.
Zurück zum Zitat Krabbe KS, Pedersen M, Bruunsgaard H (2004) Inflammatory mediators in the elderly. Exp Gerontol 39:687–699 PubMedCrossRef Krabbe KS, Pedersen M, Bruunsgaard H (2004) Inflammatory mediators in the elderly. Exp Gerontol 39:687–699 PubMedCrossRef
26.
Zurück zum Zitat Cerejeira J, Firmino H, Vaz-Serra A et al (2010) The neuroinflammatory hypothesis of delirium. Acta Neuropathol 119:737–754 PubMedCrossRef Cerejeira J, Firmino H, Vaz-Serra A et al (2010) The neuroinflammatory hypothesis of delirium. Acta Neuropathol 119:737–754 PubMedCrossRef
27.
Zurück zum Zitat de Rooji SE, van Munster BC, Korevaar JC et al (2007) Cytokines and acute phase response in delirium. J Psychosom Res 62:521–525 CrossRef de Rooji SE, van Munster BC, Korevaar JC et al (2007) Cytokines and acute phase response in delirium. J Psychosom Res 62:521–525 CrossRef
28.
Zurück zum Zitat Beloosesky Y, Hendel D, Weiss A et al (2007) Cytokines and C‑reactive production in hip-fracture-operated elderly patients. J Gerontol 62:420–426 CrossRef Beloosesky Y, Hendel D, Weiss A et al (2007) Cytokines and C‑reactive production in hip-fracture-operated elderly patients. J Gerontol 62:420–426 CrossRef
29.
Zurück zum Zitat Uchikado H, Akiyama H, Kondo H et al (2004) Activation of vascular endothelial cells and perivascular cells by systemic inflammation – an immunohistochemical study of postmortem human brain tissues. Acta Neuropathol 107:341–351 PubMedCrossRef Uchikado H, Akiyama H, Kondo H et al (2004) Activation of vascular endothelial cells and perivascular cells by systemic inflammation – an immunohistochemical study of postmortem human brain tissues. Acta Neuropathol 107:341–351 PubMedCrossRef
30.
Zurück zum Zitat Hshieh TT, Fong TG, Marcantonio ER et al (2008) Cholinergic deficiency hypothesis in delirium: a synthesis of current evidence. J Gerontol A Biol Sci Med Sci 63:764–772 PubMedPubMedCentralCrossRef Hshieh TT, Fong TG, Marcantonio ER et al (2008) Cholinergic deficiency hypothesis in delirium: a synthesis of current evidence. J Gerontol A Biol Sci Med Sci 63:764–772 PubMedPubMedCentralCrossRef
31.
Zurück zum Zitat Vendemiale G, Grattagliano I, Altomare E (1999) An update on the role of free radicals and antioxidant defense in human disease. Int J Clin Lab Res 29:49–55 PubMedCrossRef Vendemiale G, Grattagliano I, Altomare E (1999) An update on the role of free radicals and antioxidant defense in human disease. Int J Clin Lab Res 29:49–55 PubMedCrossRef
32.
Zurück zum Zitat Karlidag R, Unal S, Sezer OH et al (2006) The role of oxidative stress in postoperative delirium. Gen Hosp Psychiatry 28:418–423 PubMedCrossRef Karlidag R, Unal S, Sezer OH et al (2006) The role of oxidative stress in postoperative delirium. Gen Hosp Psychiatry 28:418–423 PubMedCrossRef
33.
Zurück zum Zitat Berr C, Balansard B, Arnaud J et al (2000) Cognitive decline is associated with systemic oxidative stress: the EVA study. J Am Geriatr Soc 48:1285–1291 PubMedCrossRef Berr C, Balansard B, Arnaud J et al (2000) Cognitive decline is associated with systemic oxidative stress: the EVA study. J Am Geriatr Soc 48:1285–1291 PubMedCrossRef
35.
Zurück zum Zitat Gibson GE, Blass JP (1976) Impaired synthesis of acetylcholine in brain accompanying mild hypoxia and hypoglycemia. J Neurochem 27:37–42 PubMedCrossRef Gibson GE, Blass JP (1976) Impaired synthesis of acetylcholine in brain accompanying mild hypoxia and hypoglycemia. J Neurochem 27:37–42 PubMedCrossRef
36.
Zurück zum Zitat Vyas S, Rodrigues AJ, Silva JM et al (2016) Chronic stress and glucocorticoids: from neuronal plasticity to neurodegeneration. Neural Plast 2016:6391686 PubMedPubMedCentralCrossRef Vyas S, Rodrigues AJ, Silva JM et al (2016) Chronic stress and glucocorticoids: from neuronal plasticity to neurodegeneration. Neural Plast 2016:6391686 PubMedPubMedCentralCrossRef
37.
Zurück zum Zitat Maclullich AM, Ferguson KJ, Miller T et al (2008) Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses. J Psychosom Res 65:229–238 PubMedPubMedCentralCrossRef Maclullich AM, Ferguson KJ, Miller T et al (2008) Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses. J Psychosom Res 65:229–238 PubMedPubMedCentralCrossRef
38.
Zurück zum Zitat O’Keffe ST, Devlin JG (1994) Delirium and the dexamethasone suppression test in the elderly. Neuropsychobiology 30:153–156 CrossRef O’Keffe ST, Devlin JG (1994) Delirium and the dexamethasone suppression test in the elderly. Neuropsychobiology 30:153–156 CrossRef
39.
Zurück zum Zitat McIntosh TK, Bush HL, Yeston NS et al (1985) Beta-endorphin, cortisol and postoperative delirium: a preliminary report. Psychoneuroendocrinology 10:303–313 PubMedCrossRef McIntosh TK, Bush HL, Yeston NS et al (1985) Beta-endorphin, cortisol and postoperative delirium: a preliminary report. Psychoneuroendocrinology 10:303–313 PubMedCrossRef
41.
Zurück zum Zitat Maldonado JR (2013) Neuropathogenesis of delirium: review of current etiologic theories and common pathways. Am J Geriatr Psychiatry 21:1190–1222 PubMedCrossRef Maldonado JR (2013) Neuropathogenesis of delirium: review of current etiologic theories and common pathways. Am J Geriatr Psychiatry 21:1190–1222 PubMedCrossRef
42.
Zurück zum Zitat McEwen BS (2006) Sleep deprivation as a neurobiologic and physiologic stressor: allostasis and allostatic load. Metabolism 55:20–23 CrossRef McEwen BS (2006) Sleep deprivation as a neurobiologic and physiologic stressor: allostasis and allostatic load. Metabolism 55:20–23 CrossRef
43.
Zurück zum Zitat Mistraletti G, Carloni E, Cigada M et al (2008) Sleep and delirium in the intensive care unit. Minerva Anestesiol 74:329–333 PubMed Mistraletti G, Carloni E, Cigada M et al (2008) Sleep and delirium in the intensive care unit. Minerva Anestesiol 74:329–333 PubMed
44.
Zurück zum Zitat Miyazaki T, Kuwano H, Kato H et al (2003) Correlation between serum melatonin circadian rhythm and intensive care unit psychosis after thoracic esophagectomy. Surgery 133:662–668 PubMedCrossRef Miyazaki T, Kuwano H, Kato H et al (2003) Correlation between serum melatonin circadian rhythm and intensive care unit psychosis after thoracic esophagectomy. Surgery 133:662–668 PubMedCrossRef
45.
Zurück zum Zitat Chen S, Shi L, Liang F et al (2016) Exogenous melatonin for delirium prevention: a meta-analysis of randomized controlled trails. Mol Neurobiol 53:4046–4053 PubMedCrossRef Chen S, Shi L, Liang F et al (2016) Exogenous melatonin for delirium prevention: a meta-analysis of randomized controlled trails. Mol Neurobiol 53:4046–4053 PubMedCrossRef
46.
Zurück zum Zitat Reade MC, Finfer S (2014) Sedation and delirium in the intensive care unit. N Engl J Med 370:444–454 PubMedCrossRef Reade MC, Finfer S (2014) Sedation and delirium in the intensive care unit. N Engl J Med 370:444–454 PubMedCrossRef
47.
Zurück zum Zitat Morandi A, Piva S, Ely EW et al (2017) Worldwide survey of the „Assessing pain, both spontaneous awakening and breathing trials, choice of drugs, delirium monitoring/management, early exercise/mobility, and family empowerment“ (ABCDEF) Bundle. Crit Care Med 45:1111–1122 CrossRef Morandi A, Piva S, Ely EW et al (2017) Worldwide survey of the „Assessing pain, both spontaneous awakening and breathing trials, choice of drugs, delirium monitoring/management, early exercise/mobility, and family empowerment“ (ABCDEF) Bundle. Crit Care Med 45:1111–1122 CrossRef
48.
Zurück zum Zitat Barr J, Fraser GL, Puntillo K et al (2013) Clinical practice guidelines for the management of pain, agitation and delirium in adult patients in the intensive care unit. Crit Care Med 41:263–306 PubMedCrossRef Barr J, Fraser GL, Puntillo K et al (2013) Clinical practice guidelines for the management of pain, agitation and delirium in adult patients in the intensive care unit. Crit Care Med 41:263–306 PubMedCrossRef
49.
Zurück zum Zitat Pandharipande P, Cotton BA, Shintani A et al (2007) Motoric subtypes of delirium in mechanically ventilated surgical and trauma intensive care unit patients. Intensive Care Med 33:1726–1731 PubMedCrossRef Pandharipande P, Cotton BA, Shintani A et al (2007) Motoric subtypes of delirium in mechanically ventilated surgical and trauma intensive care unit patients. Intensive Care Med 33:1726–1731 PubMedCrossRef
50.
Zurück zum Zitat Luetz A, Balzer F, Radtke FM et al (2014) Delirium, sedation and analgesia in the intensive care unit: a multinational, two-part survey among intensivists. PLoS ONE 9:e110935 PubMedPubMedCentralCrossRef Luetz A, Balzer F, Radtke FM et al (2014) Delirium, sedation and analgesia in the intensive care unit: a multinational, two-part survey among intensivists. PLoS ONE 9:e110935 PubMedPubMedCentralCrossRef
51.
Zurück zum Zitat Plaschke K, Petersen KA, Frankenhauser S et al (2016) The impact of plasma cholinergic enzyme activity and other risk factors for the development of delirium in patients receiving palliative care. J Pain Symptom Manage 52:525–532 PubMedCrossRef Plaschke K, Petersen KA, Frankenhauser S et al (2016) The impact of plasma cholinergic enzyme activity and other risk factors for the development of delirium in patients receiving palliative care. J Pain Symptom Manage 52:525–532 PubMedCrossRef
52.
Zurück zum Zitat Luetz A, Heymann A, Radkte FM et al (2010) Different assessment tools for intensive care unit delirium: which score to use? Crit Care Med 38:409–418 PubMedCrossRef Luetz A, Heymann A, Radkte FM et al (2010) Different assessment tools for intensive care unit delirium: which score to use? Crit Care Med 38:409–418 PubMedCrossRef
53.
Zurück zum Zitat Radkte FM, Franck M, Oppermann S et al (2009) Die Intensive Care Delirium Screening Checklist (ICDSC) Richtlinienkonforme Übersetzung und Validierung einer intensivmedizinischen Delirium-Checkliste. AINS 2:80–86 Radkte FM, Franck M, Oppermann S et al (2009) Die Intensive Care Delirium Screening Checklist (ICDSC) Richtlinienkonforme Übersetzung und Validierung einer intensivmedizinischen Delirium-Checkliste. AINS 2:80–86
54.
Zurück zum Zitat Khan BA, Perkins AJ, Gao S et al (2017) The confusion assessment method for the ICU-7 delirium severity scale: a novel delirium severity instrument for use in the ICU. Crit Care Med 45:851–857 PubMedPubMedCentralCrossRef Khan BA, Perkins AJ, Gao S et al (2017) The confusion assessment method for the ICU-7 delirium severity scale: a novel delirium severity instrument for use in the ICU. Crit Care Med 45:851–857 PubMedPubMedCentralCrossRef
55.
Zurück zum Zitat Inouye SK, Bogardus ST, Charpentier PA et al (1999) A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 340:669–676 PubMedCrossRef Inouye SK, Bogardus ST, Charpentier PA et al (1999) A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 340:669–676 PubMedCrossRef
56.
Zurück zum Zitat Jablonski J, Gray J, Miano T et al (2017) Pain, agitation and delirium guidelines: Interprofessional perspectives to translate the evidence. Dimens Crit Care Nurs 36:164–173 PubMedCrossRef Jablonski J, Gray J, Miano T et al (2017) Pain, agitation and delirium guidelines: Interprofessional perspectives to translate the evidence. Dimens Crit Care Nurs 36:164–173 PubMedCrossRef
57.
Zurück zum Zitat Slatore CG, Hansen L, Ganzini L et al (2012) Communication by nurses in the intensive care unit: qualitative analysis of domains of patient-centered care. Am J Crit Care 21:410–418 PubMedPubMedCentralCrossRef Slatore CG, Hansen L, Ganzini L et al (2012) Communication by nurses in the intensive care unit: qualitative analysis of domains of patient-centered care. Am J Crit Care 21:410–418 PubMedPubMedCentralCrossRef
58.
Zurück zum Zitat Guo Y, Fan Y (2016) A preoperative, nurse-led intervention program reduces acute postoperative delirium. J Neurosci Nurs 48:229–235 PubMedCrossRef Guo Y, Fan Y (2016) A preoperative, nurse-led intervention program reduces acute postoperative delirium. J Neurosci Nurs 48:229–235 PubMedCrossRef
60.
Zurück zum Zitat Schweickert WD, Pohlmann MC, Pohlmann AS et al (2009) Early physical and occupational therapy in mechanically ventilated, critical ill patients: a randomized controlled trail. Lancet 373:1874–1882 PubMedCrossRef Schweickert WD, Pohlmann MC, Pohlmann AS et al (2009) Early physical and occupational therapy in mechanically ventilated, critical ill patients: a randomized controlled trail. Lancet 373:1874–1882 PubMedCrossRef
61.
Zurück zum Zitat Inouye SK, Bogardus ST, Williams CS et al (2003) The role of adherence on the effectiveness of nonpharmacologic interventions. Arch Intern Med 163:958–964 PubMedCrossRef Inouye SK, Bogardus ST, Williams CS et al (2003) The role of adherence on the effectiveness of nonpharmacologic interventions. Arch Intern Med 163:958–964 PubMedCrossRef
62.
Zurück zum Zitat Alberda C, Gramlich L, Jones N et al (2009) The relationship between nutritional intake and clinical outcomes in critically ill patients: results of an international multicenter observational study. Intensive Care Med 35:1728–1737 PubMedCrossRef Alberda C, Gramlich L, Jones N et al (2009) The relationship between nutritional intake and clinical outcomes in critically ill patients: results of an international multicenter observational study. Intensive Care Med 35:1728–1737 PubMedCrossRef
63.
Zurück zum Zitat Zoremba N (2017) Delirmanagement in der Intensivmedizin – Nichtmedika-mentöse Therapieoptionen. Med Klein Intensivmed Notfmed 112:320–325 CrossRef Zoremba N (2017) Delirmanagement in der Intensivmedizin – Nichtmedika-mentöse Therapieoptionen. Med Klein Intensivmed Notfmed 112:320–325 CrossRef
64.
Zurück zum Zitat Luetz A, Weiss B, Penzel T et al (2016) Feasibility of noise reduction by a modification in ICU environment. Physiol Meas 37:1041–1055 PubMedCrossRef Luetz A, Weiss B, Penzel T et al (2016) Feasibility of noise reduction by a modification in ICU environment. Physiol Meas 37:1041–1055 PubMedCrossRef
65.
Zurück zum Zitat Hu RF, Jiang XY, Hegadoren KM et al (2015) Effects of earplugs and eye masks combined with relaxing music on sleep, melatonin and cortisol levels in ICU patients: a randomized controlled trial. Crit Care 19:115 PubMedPubMedCentralCrossRef Hu RF, Jiang XY, Hegadoren KM et al (2015) Effects of earplugs and eye masks combined with relaxing music on sleep, melatonin and cortisol levels in ICU patients: a randomized controlled trial. Crit Care 19:115 PubMedPubMedCentralCrossRef
66.
Zurück zum Zitat Czaplik M, Rossaint R, Kaliciak J et al (2016) Psychoacoustic analysis of noise and the application of earplugs in an ICU: a randomized controlled clinical trial. Eur J Anaesthesiol 33:14–21 PubMedCrossRef Czaplik M, Rossaint R, Kaliciak J et al (2016) Psychoacoustic analysis of noise and the application of earplugs in an ICU: a randomized controlled clinical trial. Eur J Anaesthesiol 33:14–21 PubMedCrossRef
67.
Zurück zum Zitat Patel J, Baldwin J, Bunting P et al (2014) The effect of a multicomponent multidisciplinary bundle of interventions on sleep and delirium in medical and surgical intensive care patients. Anaesthesia 69:540–549 PubMedCrossRef Patel J, Baldwin J, Bunting P et al (2014) The effect of a multicomponent multidisciplinary bundle of interventions on sleep and delirium in medical and surgical intensive care patients. Anaesthesia 69:540–549 PubMedCrossRef
68.
Zurück zum Zitat Böhm S (2012) Cholinerge Systeme. In: Freissmuth M (Hrsg) Pharmakologie und Toxikologie. Springer, Heidelberg Böhm S (2012) Cholinerge Systeme. In: Freissmuth M (Hrsg) Pharmakologie und Toxikologie. Springer, Heidelberg
69.
Zurück zum Zitat Pandharipande P, Shintani A, Peterson J et al (2006) Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology 104:21–26 PubMedCrossRef Pandharipande P, Shintani A, Peterson J et al (2006) Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology 104:21–26 PubMedCrossRef
70.
Zurück zum Zitat Louzon P, Jennings H, Ali M et al (2017) Impact of pharmacist management of pain, agitation, and delirium in the intensive care unit through participation in multidisciplinary bundle rounds. Am J Health Syst Pharm 74:253–262 PubMedCrossRef Louzon P, Jennings H, Ali M et al (2017) Impact of pharmacist management of pain, agitation, and delirium in the intensive care unit through participation in multidisciplinary bundle rounds. Am J Health Syst Pharm 74:253–262 PubMedCrossRef
71.
Zurück zum Zitat Siddiqi N, Harrison JK, Clegg A et al (2016) Interventions for preventing delirium in hospitalized non ICU-patients. Cochrane Database Syst Rev 3:CD5563 PubMed Siddiqi N, Harrison JK, Clegg A et al (2016) Interventions for preventing delirium in hospitalized non ICU-patients. Cochrane Database Syst Rev 3:CD5563 PubMed
72.
Zurück zum Zitat Van den Bloogaard M, Slooter AJC, Brüggemann RJM et al (2018) Effect of haloperidol on survival among critically ill adults with a high risk of delirium: The REDUCE randomized clinical trial. JAMA 319:680–690 CrossRef Van den Bloogaard M, Slooter AJC, Brüggemann RJM et al (2018) Effect of haloperidol on survival among critically ill adults with a high risk of delirium: The REDUCE randomized clinical trial. JAMA 319:680–690 CrossRef
73.
Zurück zum Zitat Chen S, Shi L, Liang F et al (2016) Endogenous melatonin for delirium prevention: a meta-analysis of randomized controlled trails. Mol Neurobiol 53:4046–4053 PubMedCrossRef Chen S, Shi L, Liang F et al (2016) Endogenous melatonin for delirium prevention: a meta-analysis of randomized controlled trails. Mol Neurobiol 53:4046–4053 PubMedCrossRef
74.
Zurück zum Zitat Su X, Meng ZT, Wu XH et al (2016) Demedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomized, double-blind, placebo-controlled trail. Lancet 388:1893–1902 PubMedCrossRef Su X, Meng ZT, Wu XH et al (2016) Demedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomized, double-blind, placebo-controlled trail. Lancet 388:1893–1902 PubMedCrossRef
76.
Zurück zum Zitat Duan X, Coburn M, Rossaint R et al (2018) Efficacy of perioperative dexmedetomidine on postoperative delirium: systematic review and meta-analysis with trial sequential analysis of randomised controlled trials. Br J Anaesth 121:384–397 PubMedCrossRef Duan X, Coburn M, Rossaint R et al (2018) Efficacy of perioperative dexmedetomidine on postoperative delirium: systematic review and meta-analysis with trial sequential analysis of randomised controlled trials. Br J Anaesth 121:384–397 PubMedCrossRef
77.
Zurück zum Zitat Shelton KT, Qu J, Bilotta F et al (2018) Minimizing ICU neurological dysfunction with dexmedetomidine-induced sleep (MINDDS): protocol for a randomised, double-blind, parallel-arm, placebo-controlled trial. BMJ Open 8:e20316 PubMedPubMedCentral Shelton KT, Qu J, Bilotta F et al (2018) Minimizing ICU neurological dysfunction with dexmedetomidine-induced sleep (MINDDS): protocol for a randomised, double-blind, parallel-arm, placebo-controlled trial. BMJ Open 8:e20316 PubMedPubMedCentral
78.
Zurück zum Zitat Barr J, Pandharipande PP (2013) The pain, agitation, and delirium care bundle: synergistic benefits of implementing the 2013 pain, agitation, and delirium guidelines in an integrated and interdisciplinary fashion. Crit Care Med 41:99–115 CrossRef Barr J, Pandharipande PP (2013) The pain, agitation, and delirium care bundle: synergistic benefits of implementing the 2013 pain, agitation, and delirium guidelines in an integrated and interdisciplinary fashion. Crit Care Med 41:99–115 CrossRef
79.
Zurück zum Zitat Reade MC, Eastwood GM, Bellomo R et al (2016) Effect of dexmede-tomidine added to standard care on ventilator-free time in patients with agitated delirium: a randomized clinical trail. JAMA 315:1460–1468 PubMedCrossRef Reade MC, Eastwood GM, Bellomo R et al (2016) Effect of dexmede-tomidine added to standard care on ventilator-free time in patients with agitated delirium: a randomized clinical trail. JAMA 315:1460–1468 PubMedCrossRef
Metadaten
Titel
Delir beim Intensivpatienten
Eine multiprofessionelle Herausforderung
verfasst von
Priv.-Doz. Dr. Norbert Zoremba, Ph.D.
Prof. Dr. Marc Coburn
Priv.-Doz. Dr. Gereon Schälte
Publikationsdatum
10.01.2019
Verlag
Springer Vienna
Schlagwort
Innere Medizin
Erschienen in
Wiener klinisches Magazin / Ausgabe 1/2019
Print ISSN: 1869-1757
Elektronische ISSN: 1613-7817
DOI
https://doi.org/10.1007/s00740-019-0268-z

Weitere Artikel der Ausgabe 1/2019

Wiener klinisches Magazin 1/2019 Zur Ausgabe

Intensivmedizin

Intestinaler Crosstalk

www.gesundheitswirtschaft.at

Mit den beiden Medien ÖKZ und QUALITAS unterstützt Gesundheitswirtschaft.at das Gesundheitssystem durch kritische Analysen und Information, schafft Interesse für notwendige Veränderungen und fördert Initiative. Die ÖKZ ist seit 1960 das bekannteste Printmedium für Führungskräfte und Entscheidungsträger im österreichischen Gesundheitssystem. Die QUALITAS verbindet seit 2002 die deutschsprachigen Experten und Praktiker im Thema Qualität in Gesundheitseinrichtungen.

zur Seite

www.pains.at

P.A.I.N.S. bietet vielfältige und aktuelle Inhalte in den Bereichen Palliativmedizin, Anästhesie, Intensivmedizin, Notfallmedizin und Schmerzmedizin. Die Informationsplattform legt einen besonderen Schwerpunkt auf hochwertige Fortbildung und bietet Updates und ausgewählte Highlight-Beiträge aus Schmerznachrichten und Anästhesie Nachrichten.

zur Seite