Delir auf der Intensivstation

Klinische Wertigkeit, Diagnostik und Therapie
Pflege

Zusammenfassung

Das Delir auf der Intensivstation ist eine akute potenziell lebensbedrohliche Organdysfunktion mit einer Inzidenz zwischen 10 und 92 %. Es ist potenziell vermeidbar und hat – auch über den Krankenhausaufenthalt hinaus – einen erheblichen Einfluss auf das Patientenoutcome. Das Delir ist mit persistierenden kognitiven Defiziten, körperlicher Abhängigkeit und Pflegebedürftigkeit, Heimbetreuung sowie einer erhöhten Mortalität assoziiert. Es ist das Ergebnis eines komplexen Zusammenspiels prädisponierender und präzipitierender Faktoren, von denen einige potenziell vermeidbar bzw. behandelbar sind.

Ein Delir wird häufig falsch oder nicht diagnostiziert. Subtyp, Schweregrad und Dauer sind mit der Prognose assoziiert. Sowohl Prävention als auch Behandlung erfordern die tägliche routinemäßige Anwendung eines Screening- und Monitoringverfahrens. Prävention erfordert Risikobewertung: Prädisponierende und auslösende Faktoren sollten erkannt und behandelt werden. Prävention und Behandlungsmöglichkeiten umfassen Verhaltens- und kognitive Trainingsprogramme und möglicherweise entzündungshemmende und antipsychotische Medikamente. Das Auftreten eines Delirs erfordert immer die Suche nach einer zugrundeliegenden Erkrankung, Intoxikation oder Medikamentennebenwirkung.

Diese Übersichtsarbeit gibt einen Überblick über klinische Bedeutung, Risikofaktoren, Pathogenese sowie nichtpharmakologische Möglichkeiten der Prävention und Intervention sowie über etablierte therapeutische Strategien für das Delir auf der Intensivstation.

Schlüsselwörter

Prävention Verwirrtheit Aufmerksamkeitsstörung Risikofaktoren Postoperative Versorgung 

Delirium on the ICU

Clinical impact, diagnostic workup, and therapy

Abstract

Delirium is an acute, potentially life-threatening organ dysfunction with an incidence reported to range between 10 and 92 %. Delirium is potentially preventable and has a great impact on patients’ outcomes, even beyond their stay in the hospital. It was found to be associated with persisting cognitive deficits, increased physical dependence, institutionalization, and increased mortality. Delirium is the result of the complex interplay of predisposing and hospital-associated precipitating risk factors, some of which are potentially preventable and modifiable.

Delirium is frequently not or incorrectly diagnosed. Subtype, severity, and duration are associated with prognosis. Both prevention and treatment necessitate implementation of daily structured delirium screening. Prevention requires risk assessment: predisposing and precipitating factors should be recognized and treated, if modifiable. Prevention and treatment options include behavioral, cognitive training programs and possibly anti-inflammatory and antipsychotic drugs. Delirium requires search for underlying illness, intoxication or drug side effects.

This review summarizes recent work from the last two years, giving a brief overview and background information with regard to risk factors, impact on outcome parameters, mechanisms of pathophysiology, non-pharmacological and pharmacological prevention and treatment strategies of delirium in critically ill patients.

Keywords

Prevention Confusion Inattention Risk factors  Postoperative care 

Literatur

  1. 1.
    Association AP (2013) Diagnostic and statistical manual of mental disorders, 5. Aufl. American Psychiatric Publishing, ArlingtonGoogle Scholar
  2. 2.
    Cunningham C, Campion S, Lunnon K et al (2009) Systemic inflammation induces acute behavioral and cognitive changes and accelerates neurodegenerative disease. Biol Psychiatry 65:304–312PubMedCentralPubMedGoogle Scholar
  3. 3.
    De Jonghe A, Van Munster BC, Van Oosten HE et al (2011) The effects of melatonin versus placebo on delirium in hip fracture patients: study protocol of a randomised, placebo-controlled, double blind trial. BMC Geriatr 11:34Google Scholar
  4. 4.
    Ely EW, Margolin R, Francis J et al (2001) Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med 29:1370–1379PubMedGoogle Scholar
  5. 5.
    Ely EW, Shintani A, Truman B et al (2004) Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 291:1753–1762PubMedGoogle Scholar
  6. 6.
    Guenther U, Weykam J, Andorfer U et al (2012) Implications of objective vs subjective delirium assessment in surgical intensive care patients. Am J Crit Care 21:e12–e20PubMedGoogle Scholar
  7. 7.
    Inouye SK (2006) Delirium in older persons. N Engl J Med 354:1157–1165PubMedGoogle Scholar
  8. 8.
    Inouye SK, Bogardus ST Jr, Charpentier PA et al (1999) A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 340:669–676PubMedGoogle Scholar
  9. 9.
    Kalisvaart KJ, De Jonghe JF, Bogaards MJ et al (2005) Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: a randomized placebo-controlled study. J Am Geriatr Soc 53:1658–1666PubMedGoogle Scholar
  10. 10.
    Lonergan E, Britton AM, Luxenberg J et al (2007) Antipsychotics for delirium. Cochrane Database Syst Rev CD005594Google Scholar
  11. 11.
    Lonergan E, Luxenberg J, Areosa SA (2009) Benzodiazepines for delirium. Cochrane Database Syst Rev CD006379Google Scholar
  12. 12.
    Luetz A, Heymann A, Radtke FM et al (2010) Different assessment tools for intensive care unit delirium: which score to use? Crit Care Med 38:409–418PubMedGoogle Scholar
  13. 13.
    Martin J, Heymann A, Basell K et al (2010) Evidence and consensus-based German guidelines for the management of analgesia, sedation and delirium in intensive care – short version. Ger Med Sci 8:Doc02PubMedCentralPubMedGoogle Scholar
  14. 14.
    Meagher DJ, Maclullich AM, Laurila JV (2008) Defining delirium for the International Classification of Diseases, 11th Revision. J Psychosom Res 65:207–214PubMedGoogle Scholar
  15. 15.
    Milbrandt EB, Deppen S, Harrison PL et al (2004) Costs associated with delirium in mechanically ventilated patients. Crit Care Med 32:955–962PubMedGoogle Scholar
  16. 16.
    Morandi A, Brummel NE, Ely EW (2011) Sedation, delirium and mechanical ventilation: the ‚ABCDE‘ approach. Curr Opin Crit Care 17:43–49PubMedGoogle Scholar
  17. 17.
    Organisation WH (1992) The International Classification of Diseases and health related problems, tenth revision (ICD-10). Mental and behavioral disorders (F00–F99). World Health Organisation, GenevaGoogle Scholar
  18. 18.
    Ouimet S, Riker R, Bergeron N et al (2007) Subsyndromal delirium in the ICU: evidence for a disease spectrum. Intensive Care Med 33:1007–1013PubMedGoogle Scholar
  19. 19.
    Pandharipande P, Cotton BA, Shintani A et al (2007) Motoric subtypes of delirium in mechanically ventilated surgical and trauma intensive care unit patients. Intensive Care Med 33:1726–1731PubMedGoogle Scholar
  20. 20.
    Pandharipande P, Cotton BA, Shintani A et al (2008) Prevalence and risk factors for development of delirium in surgical and trauma intensive care unit patients. J Trauma 65:34–41PubMedCentralPubMedGoogle Scholar
  21. 21.
    Pandharipande P, Shintani A, Peterson J et al (2006) Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology 104:21–26PubMedGoogle Scholar
  22. 22.
    Pisani MA, Kong SY, Kasl SV et al (2009) Days of delirium are associated with 1-year mortality in an older intensive care unit population. Am J Respir Crit Care Med 180:1092–1097PubMedCentralPubMedGoogle Scholar
  23. 23.
    Pisani MA, Murphy TE, Van Ness PH et al (2007) Characteristics associated with delirium in older patients in a medical intensive care unit. Arch Intern Med 167:1629–1634PubMedGoogle Scholar
  24. 24.
    Radtke FM, Franck M, Lorenz M et al (2010) Remifentanil reduces the incidence of post-operative delirium. J Int Med Res 38:1225–1232PubMedGoogle Scholar
  25. 25.
    Riker RR, Shehabi Y, Bokesch PM et al (2009) Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA 301:489–499PubMedGoogle Scholar
  26. 26.
    Ruokonen E, Parviainen I, Jakob SM et al (2009) Dexmedetomidine versus propofol/midazolam for long-term sedation during mechanical ventilation. Intensive Care Med 35:282–290PubMedGoogle Scholar
  27. 27.
    Shehabi Y, Grant P, Wolfenden H et al (2009) Prevalence of delirium with dexmedetomidine compared with morphine based therapy after cardiac surgery: a randomized controlled trial (DEXmedetomidine COmpared to Morphine-DEXCOM Study). Anesthesiology 111:1075–1084PubMedGoogle Scholar
  28. 28.
    Van Den Boogaard M, Pickkers P, Van Der Hoeven H et al (2009) Implementation of a delirium assessment tool in the ICU can influence haloperidol use. Crit Care 13:R131Google Scholar
  29. 29.
    Witlox J, Eurelings LS, De Jonghe JF et al (2010) Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA 304:443–451PubMedGoogle Scholar
  30. 30.
    Yang FM, Marcantonio ER, Inouye SK et al (2009) Phenomenological subtypes of delirium in older persons: patterns, prevalence, and prognosis. Psychosomatics 50:248–254PubMedCentralPubMedGoogle Scholar
  31. 31.
    Mackensen GB, Gelb AW (2004) Postoperative cognitive deficits: more questions than answers. Eur J Anaesthesiol 21:85–88PubMedGoogle Scholar
  32. 32.
    Sieber FE, Zakriya KJ, Gottschalk A et al (2010) Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair. Mayo Clin Proc 85:18–26PubMedCentralPubMedGoogle Scholar
  33. 33.
    Lat I, Mcmillian W, Taylor S et al (2009) The impact of delirium on clinical outcomes in mechanically ventilated surgical and trauma patients. Crit Care Med 37:1898–1905PubMedGoogle Scholar
  34. 34.
    Thomason JW, Shintani A, Peterson JF et al (2005) Intensive care unit delirium is an independent predictor of longer hospital stay: a prospective analysis of 261 non-ventilated patients. Crit Care 9:R375–R381PubMedCentralPubMedGoogle Scholar
  35. 35.
    Rudolph JL, Inouye SK, Jones RN et al (2010) Delirium: an independent predictor of functional decline after cardiac surgery. J Am Geriatr Soc 58:643–649PubMedCentralPubMedGoogle Scholar
  36. 36.
    Cole MG, You Y, Mccusker J et al (2008) The 6 and 12 month outcomes of older medical inpatients who recover from delirium. Int J Geriatr Psychiatry 23:301–307PubMedGoogle Scholar
  37. 37.
    Ouimet S, Kavanagh BP, Gottfried SB et al (2007) Incidence, risk factors and consequences of ICU delirium. Intensive Care Med 33:66–73PubMedGoogle Scholar
  38. 38.
    Bagri AS, Rico A, Ruiz JG (2008) Evaluation and management of the elderly patient at risk for postoperative delirium. Clin Geriatr Med 24:667–686, viiiPubMedGoogle Scholar
  39. 39.
    Leslie DL, Marcantonio ER, Zhang Y et al (2008) One-year health care costs associated with delirium in the elderly population. Arch Intern Med 168:27–32PubMedGoogle Scholar
  40. 40.
    Meagher D, Moran M, Raju B et al (2008) A new data-based motor subtype schema for delirium. J Neuropsychiatry Clin Neurosci 20:185–193PubMedGoogle Scholar
  41. 41.
    Meagher DJ, O’hanlon D, O’mahony E et al (2000) Relationship between symptoms and motoric subtype of delirium. J Neuropsychiatry Clin Neurosci 12:51–56PubMedGoogle Scholar
  42. 42.
    Peterson JF, Pun BT, Dittus RS et al (2006) Delirium and its motoric subtypes: a study of 614 critically ill patients. J Am Geriatr Soc 54:479–484PubMedGoogle Scholar
  43. 43.
    Inouye SK, Zhang Y, Jones RN et al (2007) Risk factors for delirium at discharge: development and validation of a predictive model. Arch Intern Med 167:1406–1413PubMedGoogle Scholar
  44. 44.
    Inouye SK, Charpentier PA (1996) Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. JAMA 275:852–857PubMedGoogle Scholar
  45. 45.
    Rudolph JL, Jones RN, Levkoff SE et al (2009) Derivation and validation of a preoperative prediction rule for delirium after cardiac surgery. Circulation 119:229–236PubMedCentralPubMedGoogle Scholar
  46. 46.
    Inouye SK (1999) Predisposing and precipitating factors for delirium in hospitalized older patients. Dement Geriatr Cogn Disord 10:393–400PubMedGoogle Scholar
  47. 47.
    Jones RN, Fong TG, Metzger E et al (2010) Aging, brain disease, and reserve: implications for delirium. Am J Geriatr Psychiatry 18:117–127PubMedCentralPubMedGoogle Scholar
  48. 48.
    Dasgupta M, Dumbrell AC (2006) Preoperative risk assessment for delirium after noncardiac surgery: a systematic review. J Am Geriatr Soc 54:1578–1589PubMedGoogle Scholar
  49. 49.
    Kazmierski J, Kowman M, Banach M et al (2010) Incidence and predictors of delirium after cardiac surgery: results from The IPDACS Study. J Psychosom Res 69:179–185PubMedGoogle Scholar
  50. 50.
    Koster S, Hensens AG, Schuurmans MJ et al (2011) Risk factors of delirium after cardiac surgery: a systematic review. Eur J Cardiovasc Nurs 10:197–204PubMedGoogle Scholar
  51. 51.
    Guenther U, Theuerkauf N, Frommann I et al (2013) Predisposing and precipitating factors of delirium after cardiac surgery: a prospective observational cohort study. Ann Surg 257:1160–1167PubMedGoogle Scholar
  52. 52.
    Rudolph JL, Jones RN, Grande LJ et al (2006) Impaired executive function is associated with delirium after coronary artery bypass graft surgery. J Am Geriatr Soc 54:937–941PubMedCentralPubMedGoogle Scholar
  53. 53.
    Radtke FM, Franck M, Macguill M et al (2010) Duration of fluid fasting and choice of analgesic are modifiable factors for early postoperative delirium. Eur J Anaesthesiol 27:411–416PubMedGoogle Scholar
  54. 54.
    Halaszynski TM (2009) Pain management in the elderly and cognitively impaired patient: the role of regional anesthesia and analgesia. Curr Opin Anaesthesiol 22:594–599PubMedGoogle Scholar
  55. 55.
    Bryson GL, Wyand A (2006) Evidence-based clinical update: general anesthesia and the risk of delirium and postoperative cognitive dysfunction. Can J Anaesth 53:669–677PubMedGoogle Scholar
  56. 56.
    Mason SE, Noel-Storr A, Ritchie CW (2010) The impact of general and regional anesthesia on the incidence of post-operative cognitive dysfunction and post-operative delirium: a systematic review with meta-analysis. J Alzheimers Dis 22(Suppl 3):67–79. doi:10.3233/JAD-2010-101086PubMedGoogle Scholar
  57. 57.
    Marcantonio ER, Goldman L, Orav EJ et al (1998) The association of intraoperative factors with the development of postoperative delirium. Am J Med 105:380–384PubMedGoogle Scholar
  58. 58.
    Chan MT, Cheng BC, Lee TM et al (2013) BIS-guided anesthesia decreases postoperative delirium and cognitive decline. J Neurosurg Anesthesiol 25:33–42PubMedGoogle Scholar
  59. 59.
    Radtke FM, Franck M, Lendner J et al (2013) Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction. Br J Anaesth 110(Suppl 1):i98–i105PubMedGoogle Scholar
  60. 60.
    Fong HK, Sands LP, Leung JM (2006) The role of postoperative analgesia in delirium and cognitive decline in elderly patients: a systematic review. Anesth Analg 102:1255–1266PubMedGoogle Scholar
  61. 61.
    Morrison RS, Magaziner J, Gilbert M et al (2003) Relationship between pain and opioid analgesics on the development of delirium following hip fracture. J Gerontol A Biol Sci Med Sci 58:76–81PubMedGoogle Scholar
  62. 62.
    Sockalingam S, Parekh N, Bogoch II et al (2005) Delirium in the postoperative cardiac patient: a review. J Card Surg 20:560–567PubMedGoogle Scholar
  63. 63.
    Bruce AJ, Ritchie CW, Blizard R et al (2007) The incidence of delirium associated with orthopedic surgery: a meta-analytic review. Int Psychogeriatr 19:197–214PubMedGoogle Scholar
  64. 64.
    Murray C, Sanderson DJ, Barkus C et al (2012) Systemic inflammation induces acute working memory deficits in the primed brain: relevance for delirium. Neurobiol Aging 33:603–616PubMedCentralPubMedGoogle Scholar
  65. 65.
    Cerejeira J, Firmino H, Vaz-Serra A et al (2010) The neuroinflammatory hypothesis of delirium. Acta Neuropathol 119:737–754PubMedGoogle Scholar
  66. 66.
    Garden GA, Moller T (2006) Microglia biology in health and disease. J Neuroimmune Pharmacol 1:127–137PubMedGoogle Scholar
  67. 67.
    Perry VH (2004) The influence of systemic inflammation on inflammation in the brain: implications for chronic neurodegenerative disease. Brain Behav Immun 18:407–413PubMedGoogle Scholar
  68. 68.
    Terrando N, Monaco C, Ma D et al (2010) Tumor necrosis factor-alpha triggers a cytokine cascade yielding postoperative cognitive decline. Proc Natl Acad Sci U S A 107:20518–20522PubMedCentralPubMedGoogle Scholar
  69. 69.
    Burkhart CS, Dell-Kuster S, Gamberini M et al (2010) Modifiable and nonmodifiable risk factors for postoperative delirium after cardiac surgery with cardiopulmonary bypass. J Cardiothorac Vasc Anesth 24:555–559PubMedGoogle Scholar
  70. 70.
    Mcgrane S, Girard TD, Thompson JL et al (2011) Procalcitonin and C-reactive protein levels at admission as predictors of duration of acute brain dysfunction in critically ill patients. Crit Care 15:R78PubMedCentralPubMedGoogle Scholar
  71. 71.
    Blauth CI (1995) Macroemboli and microemboli during cardiopulmonary bypass. Ann Thorac Surg 59:1300–1303PubMedGoogle Scholar
  72. 72.
    Edmonds CR, Barbut D, Hager D et al (2000) Intraoperative cerebral arterial embolization during total hip arthroplasty. Anesthesiology 93:315–318PubMedGoogle Scholar
  73. 73.
    Koch S, Forteza A, Lavernia C et al (2007) Cerebral fat microembolism and cognitive decline after hip and knee replacement. Stroke 38:1079–1081PubMedGoogle Scholar
  74. 74.
    Rudolph JL, Babikian VL, Treanor P et al (2009) Microemboli are not associated with delirium after coronary artery bypass graft surgery. Perfusion 24:409–415PubMedCentralPubMedGoogle Scholar
  75. 75.
    Han L, Mccusker J, Cole M et al (2001) Use of medications with anticholinergic effect predicts clinical severity of delirium symptoms in older medical inpatients. Arch Intern Med 161:1099–1105PubMedGoogle Scholar
  76. 76.
    Hshieh TT, Fong TG, Marcantonio ER et al (2008) Cholinergic deficiency hypothesis in delirium: a synthesis of current evidence. J Gerontol A Biol Sci Med Sci 63:764–772PubMedCentralPubMedGoogle Scholar
  77. 77.
    Guenther U, Popp J, Koecher L et al (2010) Validity and reliability of the CAM-ICU flowsheet to diagnose delirium in surgical ICU patients. J Crit Care 25:144–151PubMedGoogle Scholar
  78. 78.
    Bergeron N, Dubois MJ, Dumont M et al (2001) Intensive care delirium screening checklist: evaluation of a new screening tool. Intensive Care Med 27:859–864PubMedGoogle Scholar
  79. 79.
    Gaudreau JD, Gagnon P, Harel F et al (2005) Fast, systematic, and continuous delirium assessment in hospitalized patients: the nursing delirium screening scale. J Pain Symptom Manage 29:368–375PubMedGoogle Scholar
  80. 80.
    Otter H, Martin J, Basell K et al (2005) Validity and reliability of the DDS for severity of delirium in the ICU. Neurocrit Care 2:150–158PubMedGoogle Scholar
  81. 81.
    Radtke FM, Heymann A, Franck M et al (2012) How to implement monitoring tools for sedation, pain and delirium in the intensive care unit: an experimental cohort study. Intensive Care Med 38:1974–1981PubMedGoogle Scholar
  82. 82.
    Van Eijk MM, Roes KC, Honing ML et al (2010) Effect of rivastigmine as an adjunct to usual care with haloperidol on duration of delirium and mortality in critically ill patients: a multicentre, double-blind, placebo-controlled randomised trial. Lancet 376:1829–1837Google Scholar
  83. 83.
    Marcantonio ER, Flacker JM, Wright RJ et al (2001) Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc 49:516–522PubMedGoogle Scholar
  84. 84.
    Chen CC, Lin MT, Tien YW et al (2011) Modified hospital elder life program: effects on abdominal surgery patients. J Am Coll Surg 213:245–252PubMedGoogle Scholar
  85. 85.
    Pandharipande PP, Pun BT, Herr DL et al (2007) Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA 298:2644–2653PubMedGoogle Scholar
  86. 86.
    Dubois MJ, Bergeron N, Dumont M et al (2001) Delirium in an intensive care unit: a study of risk factors. Intensive Care Med 27:1297–1304PubMedGoogle Scholar
  87. 87.
    Pisani MA, Murphy TE, Araujo KL et al (2009) Benzodiazepine and opioid use and the duration of intensive care unit delirium in an older population. Crit Care Med 37:177–183PubMedCentralPubMedGoogle Scholar
  88. 88.
    Prakanrattana U, Prapaitrakool S (2007) Efficacy of risperidone for prevention of postoperative delirium in cardiac surgery. Anaesth Intensive Care 35:714–719PubMedGoogle Scholar
  89. 89.
    Larsen KA, Kelly SE, Stern TA et al (2010) Administration of olanzapine to prevent postoperative delirium in elderly joint-replacement patients: a randomized, controlled trial. Psychosomatics 51:409–418PubMedGoogle Scholar
  90. 90.
    Katznelson R, Djaiani GN, Borger MA et al (2009) Preoperative use of statins is associated with reduced early delirium rates after cardiac surgery. Anesthesiology 110:67–73PubMedGoogle Scholar
  91. 91.
    Hudetz JA, Patterson KM, Iqbal Z et al (2009) Ketamine attenuates delirium after cardiac surgery with cardiopulmonary bypass. J Cardiothorac Vasc Anesth 23:651–657PubMedGoogle Scholar
  92. 92.
    Terrando N, Rei FA, Vizcaychipi M et al (2010) The impact of IL-1 modulation on the development of lipopolysaccharide-induced cognitive dysfunction. Crit Care 14:R88PubMedCentralPubMedGoogle Scholar
  93. 93.
    Liptzin B, Laki A, Garb JL et al (2005) Donepezil in the prevention and treatment of post-surgical delirium. Am J Geriatr Psychiatry 13:1100–1106PubMedGoogle Scholar
  94. 94.
    Sampson EL, Raven PR, Ndhlovu PN et al (2007) A randomized, double-blind, placebo-controlled trial of donepezil hydrochloride (Aricept) for reducing the incidence of postoperative delirium after elective total hip replacement. Int J Geriatr Psychiatry 22:343–349PubMedGoogle Scholar
  95. 95.
    Gamberini M, Bolliger D, Lurati Buse GA et al (2009) Rivastigmine for the prevention of postoperative delirium in elderly patients undergoing elective cardiac surgery – a randomized controlled trial. Crit Care Med 37:1762–1768PubMedGoogle Scholar
  96. 96.
    Funk W, Hollnberger H, Geroldinger J (2008) Physostigmine and anaesthesia emergence delirium in preschool children: a randomized blinded trial. Eur J Anaesthesiol 25:37–42PubMedGoogle Scholar
  97. 97.
    Fitzgerald JM, Adamis D, Trzepacz PT et al (2013) Delirium: a disturbance of circadian integrity? Med Hypotheses 81:568–576PubMedGoogle Scholar
  98. 98.
    Sultan SS (2010) Assessment of role of perioperative melatonin in prevention and treatment of postoperative delirium after hip arthroplasty under spinal anesthesia in the elderly. Saudi J Anaesth 4:169–173PubMedCentralPubMedGoogle Scholar
  99. 99.
    Kress JP, Pohlman AS, O’connor MF et al (2000) Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 342:1471–1477PubMedGoogle Scholar
  100. 100.
    Chanques G, Jaber S, Barbotte E et al (2006) Impact of systematic evaluation of pain and agitation in an intensive care unit. Crit Care Med 34:1691–1699PubMedGoogle Scholar
  101. 101.
    Girard TD, Kress JP, Fuchs BD et al (2008) Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet 371:126–134PubMedGoogle Scholar
  102. 102.
    Jakob SM, Lubszky S, Friolet R et al (2007) Sedation and weaning from mechanical ventilation: effects of process optimization outside a clinical trial. J Crit Care 22:219–228PubMedGoogle Scholar
  103. 103.
    Kastrup M, Von DV, Seeling M et al (2009) Key performance indicators in intensive care medicine. A retrospective matched cohort study. J Int Med Res 37:1267–1284PubMedGoogle Scholar
  104. 104.
    Jacobi J, Fraser GL, Coursin DB et al (2002) Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 30:119–141PubMedGoogle Scholar
  105. 105.
    Treggiari MM, Romand JA, Yanez ND et al (2009) Randomized trial of light versus deep sedation on mental health after critical illness. Crit Care Med 37:2527–2534PubMedGoogle Scholar
  106. 106.
    Strom T, Martinussen T, Toft P (2010) A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. Lancet 375:475–480PubMedGoogle Scholar
  107. 107.
    Reade MC, O’sullivan K, Bates S et al (2009) Dexmedetomidine vs. haloperidol in delirious, agitated, intubated patients: a randomised open-label trial. Crit Care 13:R75PubMedCentralPubMedGoogle Scholar
  108. 108.
    Maldonado JR, Wysong A, Van Der Starre PJ et al (2009) Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery. Psychosomatics 50:206–217PubMedGoogle Scholar
  109. 109.
    Pandharipande PP, Sanders RD, Girard TD et al (2010) Effect of dexmedetomidine versus lorazepam on outcome in patients with sepsis: an a priori-designed analysis of the MENDS randomized controlled trial. Crit Care 14:R38PubMedCentralPubMedGoogle Scholar
  110. 110.
    Tan JA, Ho KM (2010) Use of dexmedetomidine as a sedative and analgesic agent in critically ill adult patients: a meta-analysis. Intensive Care Med 36:926–939PubMedGoogle Scholar
  111. 111.
    Schweickert WD, Pohlman MC, Pohlman AS et al (2009) Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 373:1874–1882PubMedGoogle Scholar
  112. 112.
    Pandharipande P, Banerjee A, Mcgrane S et al (2010) Liberation and animation for ventilated ICU patients: the ABCDE bundle for the back-end of critical care. Crit Care 14:157PubMedCentralPubMedGoogle Scholar
  113. 113.
    Bourne RS, Tahir TA, Borthwick M et al (2008) Drug treatment of delirium: past, present and future. J Psychosom Res 65:273–282PubMedGoogle Scholar
  114. 114.
    Parellada E, Baeza I, De PJ et al (2004) Risperidone in the treatment of patients with delirium. J Clin Psychiatry 65:348–353PubMedGoogle Scholar
  115. 115.
    Skrobik YK, Bergeron N, Dumont M et al (2004) Olanzapine vs haloperidol: treating delirium in a critical care setting. Intensive Care Med 30:444–449PubMedGoogle Scholar
  116. 116.
    Oldenbeuving AW, De Kort PL, Jansen BP et al (2008) A pilot study of rivastigmine in the treatment of delirium after stroke: a safe alternative. BMC Neurol 8:34. doi:10.1186/1471-2377-8-34PubMedCentralPubMedGoogle Scholar
  117. 117.
    Overshott R, Vernon M, Morris J et al (2010) Rivastigmine in the treatment of delirium in older people: a pilot study. Int Psychogeriatr 22:812–818PubMedGoogle Scholar
  118. 118.
    Stagno D, Gibson C, Breitbart W (2004) The delirium subtypes: a review of prevalence, phenomenology, pathophysiology, and treatment response. Palliat Support Care 2:171–179PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Klinik und Poliklinik für Anästhesiologie und Operative IntensivmedizinRheinische Friedrich-Wilhelms Universität BonnBonnDeutschland

Personalised recommendations