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Intensivmedizin und Palliativmedizin für beatmete neurologische Patienten

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Neurologische Beatmungsmedizin

Zusammenfassung

Intensivmedizin und Palliativmedizin wurden lange Zeit als widersprüchliche Konzepte angesehen: während die intensivmedizinische Behandlung die Lebensverlängerung anstrebt, soll die Palliativmedizin eine möglichst gute Lebensqualität schaffen. Heute gewinnen palliative Aspekte in der Intensivmedizin an Bedeutung. Dies trägt der signifikanten Mortalität auf Intensivstationen Rechnung. Ärzte und Angehörige überschätzen die Prognose von Intensivpatienten und unterschätzen die Mortalität. Neurologische Intensivpatienten bieten besondere Herausforderungen: Die Patienten und ihre Familien erleben oft eine plötzliche Verschlechterung von Kognition und Funktion und die Ärzte sind mit einer unsicheren Prognosestellung konfrontiert. Die meisten Intensivpatienten leiden außerdem an nicht ausreichend behandelten Symptomen wie Delir, Stress, Angst, Depression. Dyspnoe und Schmerz. Eine möglichst frühe Integration von Palliativmedizin in die Intensivbehandlung ist notwendig, um Therapieziele korrekt zu definieren, unnötiges Leid zu vermeiden und Patienten und Angehörigen emotional zu unterstützen. In diesem Kapitel werden der aktuelle Bedarf an der Schnittstelle zwischen Intensiv- und Palliativmedizin begründet, die ethischen Grundsätze diskutiert, Vorschläge zur Gestaltung der Schnittstelle gemacht und die Beendigung der Beatmungstherapie reflektiert.

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Authors and Affiliations

  1. Klinik für Neurologie, Krankenhaus Agatharied, Hausham, Deutschland

    Stefan Lorenzl

  2. Klinik für Neurologische Intensivmedizin und Frührehabilitation und Interdisziplinäres Palliativzentrum, Evangelisches Krankenhaus Oldenburg, Oldenburg, Deutschland

    Martin Groß

  3. Universitätsklinik für Neurologie, Evangelisches Krankenhaus Oldenburg, Oldenburg, Deutschland

    Marziyeh Tajvarpour

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  1. Klinik für Neurologische Intensivmedizin und Frührehabilitation, Evangelisches Krankenhaus Oldenburg, Oldenburg, Germany

    Martin Groß

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Lorenzl, S., Groß, M., Tajvarpour, M. (2020). Intensivmedizin und Palliativmedizin für beatmete neurologische Patienten. In: Groß, M. (eds) Neurologische Beatmungsmedizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-59014-0_22

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