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Neurologische und psychische Langzeitfolgen der Sepsis

Neurological and psychological long-term effects of sepsis

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Zusammenfassung

Hintergrund

Neben Einschränkungen der gesundheitsbezogenen Lebensqualität leidet eine Vielzahl von ehemaligen Sepsispatienten unter funktionellen Einschränkungen, die unter den Begriffen Critical-Illness-Polyneuropathie (CIP) bzw. Critical-Illness-Myopathie (CIM) seit mehr als 2 Jahrzehnten bekannt sind.

Aktueller Fokus

Im Zusammenhang mit der perihospitalen funktionellen Entwicklung geraten das Delirium während der Intensivtherapie sowie anhaltende neurokognitive Einschränkungen, posttraumatische Belastungsstörung (PTBS) und Depressionen zunehmend in den Blickpunkt.

Ausblick

Der Grad der durch eine Sepsis resultierenden Funktionsdefizite und somit die tatsächliche Lebensqualität der Betroffenen kann durch eine geeignete Rehabilitationsmaßnahme durchaus beeinflussbar sein. Allerdings gibt es bis heute weder therapeutische Rehabilitationsstandards noch auf diese Patienten ausgerichtete Rehabilitationseinrichtungen.

Abstract

Background

In addition to the limitations to the health-related quality of life that have been compiled with validated test instruments, a number of former sepsis patients suffer from functional impairments, which are categorized under the terms critical illness polyneuropathy (CIP) or critical illness myopathy (CIM), which have been in existence for over 20 years now.

Current focus

The issues of delirium during intensive therapy and persistent residual neurocognitive impairments, posttraumatic stress disorder (PTSD) and states of depression related to perihospital functional development have increasingly attracted notice.

Future

The degree of functional deficits resulting from sepsis and the actual quality of life of those affected may, however, be influenced by taking appropriate rehabilitation measures. However, neither therapeutic rehabilitation standards nor any rehabilitation facilities tailored to the needs of these patients currently exist.

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Literatur

  1. Heublein S, Hartmann M, Hagel S et al (2013) Epidemiology of sepsis in German hospitals derived from administrative databases. 6th International Congress on Sepsis and Multiorgan Dysfunction, September 4–6 2013, Weimar. Infection 41(1):Suppl

    Google Scholar 

  2. Engel C, Brunkhorst FM, Bone HG et al (2007) Epidemiology of sepsis in Germany: results from a national prospective multicenter study. Intensive Care Med 33:606–618

    Article  PubMed  Google Scholar 

  3. Esteban A, Frutos-Vivar F, Ferguson ND et al (2007) Sepsis incidence and outcome: contrasting the intensive care unit with the hospital ward. Crit Care Med 35(5):1284–1289

    Article  PubMed  Google Scholar 

  4. Latronico N, Bolton CF (2011) Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis. Lancet Neurol 10:931–941

    Article  PubMed  Google Scholar 

  5. Grimm A, Günther A, Witte OW et al (2012) Critical-Illness-Polyneuropathie und Critical-Illness-Myopathie. Med Klin Intensivmed Notfmed 107:649–660

    Article  CAS  PubMed  Google Scholar 

  6. Lacomis D, Zochodne DW, Bird SJ (2000) Critical illness myopathy. Muscle Nerve 23:1785–1788

    Article  CAS  PubMed  Google Scholar 

  7. Stevens RD, Dowdy DW, Michaels RK et al (2007) Neuromuscular dysfunction acquired in critical illness: a systematic review. Intensive Care Med 33:1876–1891

    Article  PubMed  Google Scholar 

  8. Herridge MS, Tansey CM, Matté A et al (2011) Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med 364:1293–1304

    Article  CAS  PubMed  Google Scholar 

  9. Hough CL, Herridge MS (2012) Long-term outcome after acute lung injury. Curr Opin Crit Care 18:8–15

    Article  PubMed  Google Scholar 

  10. Zielske J, Bohne S, Brunkhorst FM et al (2014) Acute and long-term dysphagia in critically ill patients with severe sepsis: results of a prospective controlled observational study. Eur Arch Otorhinolaryngol. doi:10.1007/s00405-014-3148-6

  11. Axer H, Zinke J, Axer M et al (2013) Elektrophysiologische Diagnostik der Critical Illness Polyneuropathie und Critical Illness Myopathie. Neurophys Lab 35:18–33

    Article  Google Scholar 

  12. Hermans G, De Jonghe B, Bruyninckx F et al (2014) Interventions for preventing critical illness polyneuropathy and critical illness myopathy. Cochrane Database Syst Rev 1:CD006832

    PubMed  Google Scholar 

  13. Brunkhorst FM, Engel C, Bloos F et al (2008) Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 358:125–139

    Article  CAS  PubMed  Google Scholar 

  14. Zielske J, Bohne S, Axer H et al (2013) Dysphagie-Management im Akut- und Langzeitverlauf bei kritisch kranken intensivpflichtigen Patienten. Med Klin Intensivmed Notfmed. doi:10.1007/s00063-013-0217-3

  15. Iwashyna TJ, Ely EW, Smith DM et al (2010) Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA 304:1787–1794

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Pandharipande PP, Girard TD, Jackson JC et al (2013) Long-term cognitive impairment after critical illness. N Engl J Med 369:1306–1316

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Terborg C (2012) Septische Enzephalopathie. Med Klin Intensivmed Notfmed 107:629–633

    Article  CAS  PubMed  Google Scholar 

  18. Reade MC, Finfer S (2014) Sedation and delirium in the intensive care unit. N Engl J Med 370:444–454

    Article  CAS  PubMed  Google Scholar 

  19. Gunther ML, Morandi A, Krauskopf E et al (2012) The association between brain volumes, delirium duration, and cognitive outcomes in intensive care unit survivors: the VISIONS cohort magnetic resonance imaging study*. Crit Care Med 40:2022–2032

    Article  PubMed Central  PubMed  Google Scholar 

  20. Rosendahl J, Brunkhorst FM, Jaenichen D et al (2013) Physical and mental health in patients and spouses after intensive care of severe sepsis: a dyadic perspective on long-term sequelae testing the Actor-Partner Interdependence Model. Crit Care Med 41(1):69–75

    Article  PubMed  Google Scholar 

  21. Flatten G, Gast U, Hofmann A et al (2011) S3 – Leitlinie Posttraumatische Belastungsstörung. Trauma Gewalt 3:202–210

    Google Scholar 

  22. Schelling G, Briegel J, Roozendaal B et al (2001) The effect of stress doses of hydrocortisone during septic shock on posttraumatic stress disorder in survivors. Biol Psychiatry 50(12):978–985

    Article  CAS  PubMed  Google Scholar 

  23. Jaenichen D, Brunkhorst FM, Strauss B et al (2012) Körperliche und psychische Langzeitfolgen nach intensivmedizinischer Behandlung einer schweren Sepsis bei Patienten und Angehörigen. Psychother Psych Med 62:335–343

    Article  Google Scholar 

  24. Jones C, Bäckman C, Capuzzo M et al (2010) Intensive care diaries reduce new onset post traumatic stress disorder following critical illness: a randomised, controlled trial. Crit Care 14:R168

    Article  PubMed Central  PubMed  Google Scholar 

  25. Intiso D, Amoruso L, Zarrelli M et al (2011) Long-term functional outcome and health status of patients with critical illness polyneuromyopathy. Acta Neurol Scand 123:211–219

    Article  CAS  PubMed  Google Scholar 

  26. Zifko UA (2000) Long-term outcome of critical illness polyneuropathy. Muscle Nerve Suppl 9:S49–S52

    Article  CAS  PubMed  Google Scholar 

  27. Semmler A, Okulla T, Kaiser M et al (2013) Long-term neuromuscular sequelae of critical illness. J Neurol 260:151–157

    Article  PubMed  Google Scholar 

  28. Guarneri B, Bertolini G, Latronico N (2008) Long-term outcome in patients with critical illness myopathy or neuropathy: the Italian multicentre CRIMYNE study. J Neurol Neurosurg Psychiatry 79:838–841

    Article  CAS  PubMed  Google Scholar 

  29. Koch S, Wollersheim T, Bierbrauer J et al (2014) Long-term recovery In critical illness myopathy is complete, contrary to polyneuropathy. Muscle Nerve 50:431–436

    Article  PubMed  Google Scholar 

  30. Axer H, Grimm A, Porzelius C et al (2013) Impairment of small somatic and autonomic nerve fibres in intensive care unit patients with severe sepsis and critical illness polyneuropathy – a single center controlled observational study. BMC Neurol 13:159

    Article  PubMed  Google Scholar 

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Danksagung

Diese Arbeit wurde durch das Bundesministerium für Bildung und Forschung (BMBF), FKZ: 01EO1002, gefördert.

Einhaltung ethischer Richtlinien

Interessenkonflikt. H. Axer, J. Rosendahl und F.M. Brunkhorst geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Hans-Berger-Klinik für Neurologie, Universitätsklinikum Jena, Jena, Deutschland

    H. Axer

  2. Integriertes Forschungs- und Behandlungszentrum „Sepsis und Sepsisfolgen“, Universitätsklinikum Jena, Jena, Deutschland

    H. Axer, J. Rosendahl &  F.M. Brunkhorst

  3. Institut für Psychosoziale Medizin und Psychotherapie, Universitätsklinikum Jena, Jena, Deutschland

    J. Rosendahl

  4. Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Jena, Jena, Deutschland

    F.M. Brunkhorst

  5. Paul-Martini-Forschergruppe für Klinische Sepsisforschung, Zentrum für Klinische Studien (ZKS), Universitätsklinikum Jena, Salvador-Allende-Platz 29, 07747, Jena, Deutschland

    F.M. Brunkhorst

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  1. H. Axer
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Correspondence to F.M. Brunkhorst.

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Axer, H., Rosendahl, J. & Brunkhorst, F. Neurologische und psychische Langzeitfolgen der Sepsis. Med Klin Intensivmed Notfmed 109, 596–603 (2014). https://doi.org/10.1007/s00063-014-0380-1

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  • DOI: https://doi.org/10.1007/s00063-014-0380-1

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