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Palliative Therapiekonzepte in der Intensivmedizin

Palliative therapy concepts in intensive care medicine

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Zusammenfassung

Palliative-Care-Konzepte sind in der Behandlung kritisch kranker Patienten auf operativ-interdisziplinären Intensivstationen in Deutschland bisher kaum etabliert. Ziel solcher Konzepte ist die Verbesserung der Versorgungs- und Lebensqualität durch die interdisziplinäre Behandlung krankheitsbedingter Symptome, aber auch durch Beratung und Begleitung von Patienten und ihren Angehörigen unter Berücksichtigung der aktuellen körperlichen, seelischen, sozialen und spirituellen Situation. Der palliativmedizinische Bedarf eines Patienten lässt sich durch Anwendung von definierten Screeningkriterien prüfen. Palliative-Care-Konzepte können entweder „konsultativ“ durch externe ärztliche oder pflegerische Konsiliare oder „integrativ“ durch systematische Integration palliativmedizinischer Strukturen in den Stationsablauf der „intensive care unit“ (ICU) umgesetzt werden. Durch frühzeitige Implementierung von Palliative-Care-Konzepten im Sinne eines „advance care planning“ (ACP) kann erreicht werden, dass Therapiezielgespräche früher und häufiger stattfinden sowie Mortalität, Krankenhausverweildauer und Lebensqualität der Patienten über den Intensivstationsaufenthalt günstig beeinflusst werden. Darüber hinaus können Belastungsreaktionen von Angehörigen und Behandlern reduziert und eine höhere Behandlungszufriedenheit erzielt werden. Eine Schlüsselrolle in der Therapiezielfindung kommt der professionellen und strukturierten Kommunikation mit Patient und Angehörigen sowie der Behandler untereinander zu. Die Berücksichtigung palliativmedizinsicher Grundsätze durch ein integratives Palliative-Care-Konzept kann helfen, komplexe intensivmedizinische Krankheitsverläufe würdevoll und zielführend zu gestalten, ohne sie aktiv voranzutreiben.

Abstract

Involvement of palliative care is so far not common practice for critically ill patients on surgical intensive care units (ICUs) in Germany. The objectives of palliative care concepts are improvement of patient quality of life by relief of disease-related symptoms using an interdisciplinary approach and support of patients and their relatives considering their current physical, psychological, social and spiritual needs. The need for palliative care can be identified via defined screening criteria. Integration of palliative care can either be realized using a consultative model which focusses on involvement of palliative care consultants or an integrative model which embeds palliative care principles into the routine daily practice by the ICU team. Early integration of palliative care in terms of advance care planning (ACP) can lead to an increase in goals of care discussions and quality of life as well as a decrease of mortality and length of stay on the ICU. Moreover, stress reactions of relatives and ICU staff can be reduced and higher satisfaction with therapy can be achieved. The core of goal of care discussions is professional and well-structured communication between patients, relatives and staff. Consideration of palliative care principles by model-based integration into ICU practice can improve complex intensive care courses of disease in a productive but dignified way without neglecting curative attempts.

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Authors and Affiliations

  1. Klinik für Anästhesiologie, Universitätsmedizin, Johannes Gutenberg-Universität, Langenbeckstr. 1, 55131, Mainz, Deutschland

    M. Schuster, M. Ferner, M. Bodenstein & R. Laufenberg-Feldmann

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  1. M. Schuster
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  2. M. Ferner
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  3. M. Bodenstein
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  4. R. Laufenberg-Feldmann
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Correspondence to M. Schuster.

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M. Schuster, M. Ferner, M. Bodenstein und R. Laufenberg-Feldmann geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Schuster, M., Ferner, M., Bodenstein, M. et al. Palliative Therapiekonzepte in der Intensivmedizin. Anaesthesist 66, 233–239 (2017). https://doi.org/10.1007/s00101-017-0294-4

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