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Delir und Delirmanagement bei kritisch kranken Patienten

Delirium and delirium management in critically ill patients

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Zusammenfassung

Das Delir bei kritisch kranken Patienten ist als Ausdruck einer zerebralen Organdysfunktion eine häufige Entität auf der Intensivstation. Kennzeichnend ist eine Störung des Bewusstseins und der Kognition, verbunden mit Aufmerksamkeitsschwierigkeiten und Veränderungen der Wahrnehmung, die sich in einem zeitlichen Intervall von Stunden bis Tagen manifestieren können. Das Auftreten eines Delirs hat nachgewiesene negative Effekte auf kurz- und langfristige Outcomeparameter des Patienten und erhöht die Morbidität und Mortalität. Trotz seiner Signifikanz wird das Delir in der Routineversorgung vom intensivmedizinischen Team in vielen Fällen nicht adäquat diagnostiziert. Als Instrumente zur standardisierten Erkennung des Delirs haben sich die gut validierten Skalen der Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) und der Intensive Care Delirium Screening Checklist (ICDSC) etabliert. Diese sind sowohl für ärztliches als auch nichtärztliches Personal einfach anwendbar. Die Therapie des Delirs ist bestimmt durch nichtpharmakologische Maßnahmen. Ziele sind die frühe Identifikation, Reorientierung und Mobilisierung des Patienten, darüber hinaus die Förderung der geistigen Aktivität und die Etablierung eines adäquaten Tag-Nacht-Rhythmus. Die Evidenz bezüglich der pharmakologischen Therapie ist gering, wobei die Wahl der sedierenden Medikation einen nachgewiesenen Einfluss auf Entstehung und Dauer eines Delirs auf der Intensivstation hat.

Abstract

Delirium in critically ill patients is a common entity in the intensive care unit (ICU) and is an expression of the cerebral organ dysfunction of the patient. The hallmark signs are disturbed consciousness and cognition in combination with inattentiveness and alterations in perception, which are manifested within a time interval of hours to days during treatment on the ICU. Delirium has been shown to have negative effects on patient short-term and long-term outcome parameters and increases morbidity and mortality. Despite its significance in many cases delirium remains inadequately diagnosed during routine treatment by ICU personnel. There are two validated and easily applicable scales for the standardized diagnosis of delirium: the confusion assessment method for the ICU (CAM-ICU) and the intensive care delirium screening checklist (ICDSC). These are simple to apply by medical as well as non-medical personnel. The therapy of delirium is mostly determined by non-pharmacological measures aiming at early identification, reorientation and mobilization of the patient, improving cerebral activity and establishing adequate wake-sleep cycles. There is only sparse evidence for pharmacological treatment of delirium; however, the choice of sedative agent has a proven effect on the incidence and duration of delirium in the ICU.

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  1. Medizinische Klinik I, Universitätsklinikum der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland

    A. Kersten &  S. Reith

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Kersten, A., Reith, S. Delir und Delirmanagement bei kritisch kranken Patienten. Med Klin Intensivmed Notfmed 111, 14–21 (2016). https://doi.org/10.1007/s00063-015-0130-z

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