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Delir auf der Intensivstation

Delirium in the intensive care unit

  • Intensivmedizin
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Zusammenfassung

Das Intensivdelir bzw. das Delir des Intensivpatienten erfährt in den letzten Jahren international ein zunehmendes Interesse der Intensivmediziner. Auf deutschen Intensivstationen hingegen scheint dieses hoch komplexe Krankheitsbild weiterhin eine lästige Begleiterscheinung darzustellen, dessen Bedeutung verkannt wird. Das ist insofern erstaunlich, als dass dank der Entwicklung hoch differenzierter Beatmungsgeräte für die meisten Intensivpatienten eine tiefe Analgosedierung heute oftmals obsolet ist und leicht zu handhabende Bedside-Tests erarbeitet wurden, die ein neurologisches und kognitives „scoring“ des beatmeten Intensivpatienten ermöglichen. Die Inzidenz des Intensivdelirs erweist sich dabei als überraschend hoch. In seiner Bedeutung ist das Intensivdelir als ein Organversagen zu verstehen und gilt als unabhängiger prognostischer Faktor für die Letalität und die Krankenhausverweildauer. Sowohl die Pathophysiologie als auch die Risikofaktoren sind bisher noch unzureichend verstanden. Als gesichert gilt, dass bestimmte alterassoziierte Vorerkrankungen, allen voran die Demenz, die aktuelle Diagnose bzw. der erfolgte chirurgische Eingriff und viele „Standardmedikamente“ der anästhesiologischen Prämedikation sowie der Intensivtherapie ein deutlich höheres Risiko für die Entwicklung eines Intensivdelirs nach sich ziehen. Bezüglich der Pathophysiologie des Delirs wird eine Imbalance von Neurotransmittern, insbesondere zwischen Acetylcholin (ACh) und Dopamin/Serotonin vermutet. Die therapeutischen Möglichkeiten beschränken sich bislang auf die Anwendung von reorientierenden Begleitmaßnahmen, intensiver Physiotherapie, einer adäquaten Schmerztherapie und der Gabe von Neuroleptika.

Abstract

In recent years delirium in the intensive care unit (ICU) has internationally become a matter of rising concern for intensive care physicians. Due to the design of highly sophisticated ventilators the practice of deep sedation is nowadays mostly obsolete. To assess a ventilated ICU patient for delirium easy to handle bedside tests have been developed which permit a psychiatric scoring. The significance of ICU delirium is equivalent to organ failure and has been proven to be an independent prognostic factor for mortality and length of ICU and hospital stay. The pathophysiology and risk factors of ICU delirium are still insufficiently understood in detail. A certain constellation of pre-existing patient-related conditions, the current diagnosis and surgical procedure and administered medication entail a higher risk for the occurrence of ICU delirium. A favored hypothesis is that an imbalance of the neurotransmitters acetylcholine and dopamine serotonin results in an unpredictable neurotransmission. Currently, the administration of neuroleptics, enforced physiotherapy, re-orientation measures and appropriate pain treatment are the basis of the therapeutic approach.

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  1. Klinik für Anaesthesiologie, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    R. von Haken, K. Plaschke, M. Scholz, R. Engelhardt, A. Brobeil & E. Martin

  2. Abteilung Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland

    M. Gruß & M.A. Weigand

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  1. R. von Haken
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  2. M. Gruß
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  3. K. Plaschke
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  4. M. Scholz
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  5. R. Engelhardt
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  6. A. Brobeil
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Correspondence to R. von Haken.

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R. von Haken und M. Gruß haben zu gleichen Teilen zu dieser Arbeit beigetragen.

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von Haken, R., Gruß, M., Plaschke, K. et al. Delir auf der Intensivstation. Anaesthesist 59, 235–247 (2010). https://doi.org/10.1007/s00101-009-1664-3

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