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Delir beim Intensivpatienten

Eine multiprofessionelle Herausforderung

Delirium in intensive care patients

A multiprofessional challenge

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An Erratum to this article was published on 28 November 2018

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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.

Abstract

Delirium is the most common form of cerebral dysfunction in intensive care patients and is a medical emergency that must be avoided or promptly diagnosed and treated. According to current knowledge the development of delirium seems to be caused by an interplay between increased vulnerability (predisposition) and simultaneous exposure to delirogenic factors. Since delirium is often overlooked in the clinical routine, a continuous screening for delirium should be performed. Due to the close connection between delirium, agitation and pain, sedation and analgesia must be evaluated at least every 8 h analogous to delirium screening. According to current knowledge, a multifactorial and multiprofessional approach is favored in the prevention and treatment of delirium. Non-pharmaceutical interventions through early mobilization, reorientation, sleep improvement, adequate pain therapy and avoidance of polypharmacy are of great importance. Depending on the clinical picture, different substances are used in symptom-oriented drug treatment of delirium. In order to achieve these diagnostic and therapeutic goals, an interdisciplinary treatment team consisting of intensive care, intensive care physicians, ward pharmacists, physiotherapists, nutrition specialists and psychiatrists is necessary in order to meet the requirements of the patient and their relatives.

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Change history

  • 28 November 2018

    Erratum zu:

    Anaesthesist 2018

    https://doi.org/10.1007/s00101-018-0497-3

    Im ursprünglich veröffentlichten Beitrag wird im Abschnitt „Delirprävention – Medikamentöse Prophylaxe“ und im Abschnitt „Delirtherapie“ eine falsche Dosierungsangabe für Dexmedetomidim zur Delirprävention und bei beatmeten Delirpatienten gemacht, die wegen einer Agitation nicht adäquat von der Beatmung entwöhnt werden …

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  1. Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Sankt Elisabeth Hospital Gütersloh, Stadtring Kattenstroth 130, 33332, Gütersloh, Deutschland

    N. Zoremba Ph.D.

  2. Klinik für Anästhesiologie, Universitätsklinikum der RWTH Aachen, Aachen, Deutschland

    M. Coburn & G. Schälte

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Zoremba, N., Coburn, M. & Schälte, G. Delir beim Intensivpatienten. Anaesthesist 67, 811–820 (2018). https://doi.org/10.1007/s00101-018-0497-3

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