Zusammenfassung
Der Anteil älterer, gebrechlicher und multimorbider Menschen hat in den letzten Jahrzehnten aufgrund der demographischen Entwicklung stark zugenommen bzw. wird weiter dramatisch zunehmen, was sich auf die medizinische Akutversorgung auswirken wird. Prospektive randomisierte Studien zum Themengebiet der geriatrischen Intensivmedizin fehlen bis heute. Es existieren zudem weder internationale noch nationale Empfehlungen bezüglich des Managements von kritisch kranken älteren Patienten. Das vorliegende Konsensuspapier liefert basierend auf einer konsentierten Expertenmeinung 16 Aussagen, die beim Umgang mit geriatrischen Intensivpatienten beachtet werden sollten.
Abstract
The proportion of elderly, frail, and multimorbid people has increased dramatically in recent decades resulting from demographic changes and will further increase, which will impact acute medical care. Prospective, randomized studies on geriatric intensive care are still lacking. There are also no international or national recommendations regarding the management of critically ill elderly patients. Based on an expert opinion, this consensus paper provides 16 statements that should be considered when dealing with geriatric critical care patients.
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G. Michels ist Mitglied des Wissenschaftlichen Beirats der Deutschen Gesellschaft für Internistische Intensiv- und Notfallmedizin e. V. (DGIIN), Sprecher der Arbeitsgruppe Kardiopulmonale Reanimation der Deutschen Gesellschaft für Kardiologie e. V. (DGK), Mitglied des Wissenschaftlichen Beirats der Deutschen Herzstiftung sowie Mitglied der Arbeitsgruppe ECMO/eCPR des Deutschen Rats für Wiederbelebung e. V. (German Resuscitation Council, GRC), Mitglied der Sektion Ethik der DGIIN und der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin e. V. (DIVI); G. Michels erhielt Honorare für Vortragstätigkeiten von Fa. Pfizer, Fa. Novartis, Fa. Servier, Fa. Zoll, Fa. Getinge und Fa. Orion Pharma. Die Interessenkonflikte stehen in keinem Zusammenhang mit dem vorliegenden Konsensuspapier. C.C. Sieber ist Mitglied der Deutschen Gesellschaft für Innere Medizin e. V. (DGIM; Vorsitzender 2017–2018, aktuell 1. stellv. Vorsitzender), der Schweizerischen Gesellschaft für Allgemeine Innere Medizin e. V. (SAGIM), der Deutschen Gesellschaft für Geriatrie e. V. (DGG; 2005–2008 Präsident), der Deutschen Gesellschaft für Gerontologie und Geriatrie e. V. (DGGG), der Schweizerischen Fachgesellschaft für Geriatrie e. V. (SGG), der Österreichischen Gesellschaft für Geriatrie und Gerontology e. V. (ÖGGG), der European Union Geriatric Medicine Society (EUGMS; Executive Board), der Deutschen Gesellschaft für Ernährungsmedizin e. V. (DGEM; Präsident 2010–2012), der European Society of Parenteral and Enteral Nutrition (ESPEN), der European Academy for Medicine of Ageing (EAMA; Präsident 2007–2015), der Deutschen Gesellschaft für Palliativmedizin e. V. (DGP), des Interdisziplinären Zentrums für Gerontologie an der FAU (Vize-Präsident), der Italian Society of Geriatric (SIG). G. Marx ist Vorstandsvorsitzender der Deutschen Gesellschaft für Telemedizin (DGTelemed), Mitglied des engeren Präsidiums der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin e. V. (DGAI e. V.), Mitglied des Präsidiums und President-elect der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI e. V.); G. Marx erhielt Honorare im Rahmen von Beratertätigkeiten für Fa. B. Braun Melsungen und Fa. Adrenomed, Vortragshonorare von Fa. B. Braun Melsungen, Fa. Biotest und Fa. Adrenomed sowie Forschungsgelder von Fa. B. Braun Melsungen, Fa. Biotest und Fa. Adrenomed. Die Interessenkonflikte stehen in keinem Zusammenhang mit dem vorliegenden Konsensuspapier. R. Roller-Wirnsberger ist Mitglied des Vorstands (aktuell Präsidentin) der Österreichischen Gesellschaft für Geriatrie und Gerontologie (ÖGGG). Sie ist zudem Vizepräsidentin der European Academy of Medicine of Aging (EAMA, Sitz Belgien) und Gründungs- und Vorstandsmitglied der Österreichischen Plattform für Interdisziplinäre Alternsforschung (ÖPIA) und des European Interdisciplinary Council on Ageing (EICA, Sitz San Servolo, Italien). M. Joannidis ist Mitglied des Vorstands (aktuell Präsident) der Österreichischen Gesellschaft für Internistische und Allgemeine Intensivmedizin und Notfallmedizin (ÖGIAIN). Er erhielt Vortragshonorare bzw. Beraterhonorare von Fa. Baxter Healthcare Corp, Fa. CLS Behring, Fa. Fresenius, Fa. Astute Medical sowie Forschungsförderung von Fa. Fresenius Kabi Austria. Die Interessenkonflikte stehen in keinem Zusammenhang mit dem vorliegenden Konsensuspapier. U. Müller-Werdan ist Vorstandsmitglied (aktuell Präsidentin) der Deutschen Gesellschaft für Gerontologie und Geriatrie e. V. (DGGG), Mitglied im Wissenschaftlichen Beirat der Bundesärztekammer und Mitglied des Wissenschaftlichen Beirats der Deutschen Gesellschaft für internistische Intensiv- und Notfallmedizin e. V. (DGIIN). R. Wirth ist Mitglied des Vorstands (President-elect) der Deutschen Gesellschaft für Geriatrie e. V. (DGG). Er erhielt gelegentliche Vortragshonorare von Fa. Apetito, Fa. Nutricia, Fa. Fresenius Kabi, Fa. Nestle, Fa. Shire, Fa. Desitin, Fa. Bayer HealthCare, Fa. MSD und Fa. Bristol Meyers Squibb. Weiterhin erhielt er in den letzten 3 Jahren Forschungsförderung von Fa. Nutricia, der Deutschen Gesellschaft für Ernährungsmedizin e. V. (DGEM) und der DGG. U. Janssens ist Mitglied des Vorstands (aktuell Generalsekretär) der Deutschen Gesellschaft für Internistische Intensiv- und Notfallmedizin e. V. (DGIIN), Mitglied des Vorstands (aktuell Präsident) der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin e. V. (DIVI) sowie Sprecher der Sektion Ethik der DIVI. Des Weiteren ist er Mitglied der Deutschen Gesellschaft für Kardiologie e. V. (DGK), Nukleus der AG3 (Arbeitsgruppe Kardiovaskuläre Intensiv- und Notfallmedizin). H.J. Heppner ist Mitglied des Vorstands (aktuell Präsident) der Deutschen Gesellschaft für Geriatrie e. V. (DGG), der Deutschen Gesellschaft für internistische Intensiv- und Notfallmedizin e. V. (DGIIN), der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin e. V. (DIVI) und ist stellvertretender Sprecher der Sektion Geriatrie in der Deutschen Sepsisgesellschaft. Er erhielt gelegentlich Vortragshonorare von Fa. Pfizer Pharma GmbH, Fa. Bayer Health Care, Fa. Infectopharm und Fa. Novartis. Zusätzlich erhielt er Forschungsförderung von Fa. Pfizer Pharma GmbH, Fa. Infectopharm, Fa. Deutsche Bank und Innovationsfonds des GBA. W. Müllges, G. Gahn, R. Pfister, P.A. Thürmann, J. Fresenborg, L. Kuntz und S.T. Simon geben an, dass kein Interessenkonflikt besteht.
Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
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Dieses Konsensuspapier erscheint parallel in den Zeitschriften Medizinische Klinik – Intensivmedizin und Notfallmedizin und in der Zeitschrift für Gerontologie und Geriatrie.
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Michels, G., Sieber, C.C., Marx, G. et al. Geriatrische Intensivmedizin. Med Klin Intensivmed Notfmed 115, 393–411 (2020). https://doi.org/10.1007/s00063-019-0590-7
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DOI: https://doi.org/10.1007/s00063-019-0590-7