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Delir auf der Intensivstation

Klinische Wertigkeit, Diagnostik und Therapie

Delirium on the ICU

Clinical impact, diagnostic workup, and therapy

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.

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.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. U. Guenther hat von der Firma Orion Pharma Honorare für Lesungen erhalten. N. Theuerkauf gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Theuerkauf, N., Guenther, U. Delir auf der Intensivstation . Med Klin Intensivmed Notfmed 109, 129–136 (2014). https://doi.org/10.1007/s00063-014-0354-3

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Schlüsselwörter

  • Prävention
  • Verwirrtheit
  • Aufmerksamkeitsstörung
  • Risikofaktoren
  • Postoperative Versorgung

Keywords

  • Prevention
  • Confusion
  • Inattention
  • Risk factors
  • Postoperative care