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Schmerz, Unruhe und Delir bei akuter respiratorischer Insuffizienz

Pain, agitation and delirium in acute respiratory failure

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Zusammenfassung

Das Vermeiden von Schmerzen, Unruhe und Delir einerseits und von unnötig tiefer Sedierung andererseits ist eine wirksame, aber auch herausfordernde Behandlungsstrategie in der Intensivmedizin. Bei Patienten mit respiratorischer Insuffizienz und Bedarf an Beatmung gibt es eine Reihe relevanter Wechselwirkungen zwischen Gehirnfunktion und Atmung, deren Berücksichtigung die Behandlung erleichtert. Bei vielen invasiv beatmeten Patienten ist ein wacher, schmerzfreier und orientierter Zustand im Sinne einer kooperativen Sedierungsstrategie möglich. Von einer erhaltenen Spontanatmung scheinen v. a. Patienten mit leichtgradigem „acute respiratory distress syndrome“ (ARDS) zu profitieren. Die völlige Ausschaltung der Spontanatmung mit oder ohne neuromuskuläre Blockade ist keine Standardstrategie beim ARDS, kann jedoch bei ausgeprägter Dyssynchronie trotz ausreichender Analgosedierung und/oder bei persistierender Hypoxämie punktuell versucht werden. Während nichtinvasiver Beatmung sowie in der Phase der Beatmungsentwöhnung sollten Schmerzen, Agitation und Delir ebenfalls besonders berücksichtigt werden, da sie die Atemfunktion beeinträchtigen und damit den Behandlungserfolg gefährden. Eine medikamentöse Anxiolyse bzw. eine Sedierung können in diesen Situationen hilfreich sein, sollten aber nicht reflexhaft oder unkritisch verabreicht werden.

Abstract

Avoiding pain, agitation and delirium as well as avoiding unnecessary deep sedation is a powerful yet challenging strategy in critical care medicine. A number of interactions between cerebral function and respiratory function should be regarded in patients with respiratory failure and mechanical ventilation. A cooperative sedation strategy (i.e. patient is awake and free of pain and delirium) is feasible in many patients requiring invasive mechanical ventilation. Especially patients with mild acute respiratory distress syndrome (ARDS) seem to benefit from preserved spontaneous breathing. While completely disabling spontaneous ventilation with or without neuromuscular blockade is not a standard strategy in ARDS, it might be temporarily required in patients with severe ARDS, who have substantial dyssynchrony or persistent hypoxaemia. Since pain, agitation and delirium compromise respiratory function they should also be regarded during noninvasive ventilation and during ventilator weaning. Pharmacological sedation can have favourable effects in these situations, but should not be given routinely or uncritically.

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Authors and Affiliations

  1. I. Interne Lungenabteilung mit Intensivstation, Otto Wagner Spital, Sanatoriumstrasse 2, 1140, Wien, Österreich

    G.-C. Funk

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G.-C. Funk ist als Referent und Berater für die Firma Orion Pharma tätig.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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H. Hetz, Wien

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Funk, GC. Schmerz, Unruhe und Delir bei akuter respiratorischer Insuffizienz. Med Klin Intensivmed Notfmed 111, 29–36 (2016). https://doi.org/10.1007/s00063-015-0136-6

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  • DOI: https://doi.org/10.1007/s00063-015-0136-6

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