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Erschienen in: ProCare 5/2016

01.06.2016 | intensivpflege

Delir und Delirmanagement bei kritisch kranken Patienten

Nichtpharmakologische Maßnahmen bestimmen Prävention und Therapie

verfasst von: Dr. Alexander Kersten, Priv.-Doz. Dr. Sebastian Reith

Erschienen in: ProCare | Ausgabe 5/2016

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Zusammenfassung

Das Delir bei kritisch kranken Patienten ist als Ausdruck einer zerebralen Organdysfunktion eine häufige Entität auf der Intensivstation. Kennzeichnend ist eine Störung des Bewusstseins und der Kognition, verbunden mit Aufmerksamkeitsschwierigkeiten und Veränderungen der Wahrnehmung, die sich in einem zeitlichen Intervall von Stunden bis Tagen manifestieren können. Das Auftreten eines Delirs hat nachgewiesene negative Effekte auf kurz- und langfristige Outcomeparameter des Patienten und erhöht die Morbidität und Mortalität. Trotz seiner Signifikanz wird das Delir in der Routineversorgung vom intensivmedizinischen Team in vielen Fällen nicht adäquat diagnostiziert. Als Instrumente zur standardisierten Erkennung des Delirs haben sich die gut validierten Skalen der Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) und der Intensive Care Delirium Screening Checklist (ICDSC) etabliert. Diese sind sowohl für ärztliches als auch nichtärztliches Personal einfach anwendbar. Die Therapie des Delirs ist bestimmt durch nichtpharmakologische Maßnahmen. Ziele sind die frühe Identifikation, Reorientierung und Mobilisierung des Patienten, darüber hinaus die Förderung der geistigen Aktivität und die Etablierung eines adäquaten Tag-Nacht-Rhythmus. Die Evidenz bezüglich der pharmakologischen Therapie ist gering, wobei die Wahl der sedierenden Medikation einen nachgewiesenen Einfluss auf Entstehung und Dauer eines Delirs auf der Intensivstation hat.
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Metadaten
Titel
Delir und Delirmanagement bei kritisch kranken Patienten
Nichtpharmakologische Maßnahmen bestimmen Prävention und Therapie
verfasst von
Dr. Alexander Kersten
Priv.-Doz. Dr. Sebastian Reith
Publikationsdatum
01.06.2016
Verlag
Springer Vienna
Erschienen in
ProCare / Ausgabe 5/2016
Print ISSN: 0949-7323
Elektronische ISSN: 1613-7574
DOI
https://doi.org/10.1007/s00735-016-0644-5