Nicht pharmakologische und pharmakologische Therapie des Delirs

 

 Buy Article Permissions and Reprints

Abstract

The therapeutic management of delirium is based on two major columns. The cornerstone of therapy is the non-pharmacological intervention using a multifactorial approach including early mobilization, reorientation, improvement of cerebral and cognitive activity and the consequent establishment of adequate wake-/sleep cycles. Evidence for specific pharmacotherapy in delirium is currently rare, for both delirium prophylaxis as well as for definitive therapy of clinically apparent delirium. However, in clinical routine several substances are commonly used for the management of delirium particularly in a symptom-oriented choice. Moreover, regarding delirium prophylaxis the choice of sedativum has an important clinical impact on the incidence of delirium.

• Literatur

• 1 Kersten A, Reith S. Delirium and delirium management in critically ill patients. Med Klinik Intensivmed Notfmed 2016; 111: 14-21
  PubMedGoogle Scholar
• 2 Ouimet S, Kavanagh BP, Gottfried SB. et al. Incidence, risk factors, and consequences of ICU delirium. Intensive Care Med 2007; 33: 66-73
  CrossrefPubMedGoogle Scholar
• 3 Baron R, Binder A, Biniek R. DAS-Taskforce 2015. et al. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015). Ger Med Sci 2015; 13 DOI: 10.3205/000223.
  PubMedGoogle Scholar
• 4 Barbateskovic M, Krauss SR, Collet MO. et al. Pharmacological interventions for prevention and management of delirium in intensive care patients: a systematic overview of reviews and meta-analyses. BMJ Open 2019; 9: e024562
  CrossrefPubMedGoogle Scholar
• 5 Barr J, Fraser GL, Puntillo K. et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 2013; 41: 263-306
  CrossrefPubMedGoogle Scholar
• 6 Inouye SK, Bogardus Jr ST, Charpentier PA. et al. A multicomponent intervention to prevent delirium in hospitalized older adults. N Engl J Med 1999; 340: 669-676
  CrossrefPubMedGoogle Scholar
• 7 Vidán MT, Sánchez E, Alonso M. et al. An intervention integrated into daily clinical practice reduces the incidence of delirium during hospitalization in elderly patients. J Am Geriatr Soc 2009; 57: 2029-2036
  CrossrefPubMedGoogle Scholar
• 8 Rivosecchi RM, Smithburger PL, Svec S. et al. Nonpharmacological interventions to prevent delirium: an evidence-based systematic review. Crit Care Nurse 2015; 35: 39-51
  PubMedGoogle Scholar
• 9 Inouye SK, Baker DI, Fugal P. et al. Dissemination of the hospital elder life program: implementation, adaption, and successes. J Am Geriatr Soc 2006; 54: 1492-1499
  CrossrefPubMedGoogle Scholar
• 10 van den Boogaard M, Pickkers P, Slooter AJ. et al. Development and validation of PRE-DELIRIC (PREdiction of DELIRium in ICU patients) delirium prediction model for intensive care patients: observational multicentre study. BMJ 2012; 344: e420
  CrossrefPubMedGoogle Scholar
• 11 Tabet N, Hudson S, Sweeney V. et al. An educational intervention can prevent delirium on acute medical wards. Age Ageing 2005; 34: 152-156
  CrossrefPubMedGoogle Scholar
• 12 Schweickert WD, Pohlman MC, Pohlman AS. et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 2009; 373: 1874-1882
  CrossrefPubMedGoogle Scholar
• 13 Devlin JW, Skrobik Y, Gelinas C. et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility and sleep disruption in adult patients in the ICU. Crit Care Med 2018; 46: e825-e873
  CrossrefPubMedGoogle Scholar
• 14 Hu RF, Jiang XY, Hegadoren KM. et al. Effects of earplugs and eye masks combined with relaxing music on sleep, melatonin and cortisol levels in ICU patients: a randomized control trial. Crit Care Med 2015; 19: 115
  PubMedGoogle Scholar
• 15 Zoremba N. Management of delirium in the intensive care unit: Non-pharmacological therapy options. Med Klin Intensivmed Notfmed 2017; 112: 320-325
  CrossrefPubMedGoogle Scholar
• 16 Kalisvaart KJ, de Jonghe JF, Bogaards MJ. et al. Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: a randomized placebo-controlled study. J Am Geriatr Soc 2005; 53: 1658-1666
  CrossrefPubMedGoogle Scholar
• 17 Wang W, Li HL, Wang DX. et al. Haloperidol prophylaxis decreases delirium incidence in elderly patients after noncardiac surgery: a randomized controlled trial. Crit Care Med 2012; 40: 731-739
  CrossrefPubMedGoogle Scholar
• 18 Prakanrattana U, Prapaitrakool S. Efficacy of risperidone for prevention of postoperative delirium in cardiac surgery. Anaesth Intensive Care 2007; 35: 714-719
  CrossrefPubMedGoogle Scholar
• 19 Riker RR, Shehabi Y, Bokesch PM. et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA 2009; 301: 489-499
  CrossrefPubMedGoogle Scholar
• 20 Pandharipande PP, Pun BT, Herr DL. et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA 2007; 298: 2644-2653
  CrossrefPubMedGoogle Scholar
• 21 Jakob SM, Ruokonen E, Grounds RM. et al. Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. JAMA 2012; 307: 1151-1160
  CrossrefPubMedGoogle Scholar
• 22 Shehabi Y, Howe BD, Bellomo R. et al. Early sedation with Dexmedetomidine in critically ill patients. N Engl J Med 2019; 380: 2506-2517
  CrossrefPubMedGoogle Scholar
• 23 Devlin JW, Roberts RJ, Fong JJ. et al. Efficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicenter, randomized, doubleblind, placebo-controlled pilot study. Crit Care Med 2010; 38: 419-427
  CrossrefPubMedGoogle Scholar
• 24 Girard TD, Pandharipande PP, Carson SS. et al. Feasibility, efficacy, and safety of antipsychotics for intensive care unit delirium: the MIND randomized, placebo-controlled trial. Crit Care Med 2010; 38: 428-437
  PubMedGoogle Scholar
• 25 Reade MC, O’Sullivan K, Bates S. et al. Dexmedetomidine vs. haloperidol in delirious, agitated, intubated patients: a randomised open-label trial. Crit Care 2009; 13: R75
  CrossrefPubMedGoogle Scholar