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Das Delir auf Intensivstationen

Ein Überblick für Pflegekräfte und Ärzte

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Weiterbildung Intensivmedizin und Notfallmedizin

Zusammenfassung

Das Delir ist eine der häufigsten akuten Organdysfunktionen während einer intensivrnedizinischen Behandlung. Seine Inzidenz ist mit 50% bei nichtbeatmeten und bis zu 80% bei beatmeten Patienten sehr hoch. Im Rahmen der klinischen Routineversorgung von kritisch kranken Patienten bleibt es, insbesondere wegen der mangelhaften Implementierung valider Messinstrumente, häufig unerkannt. Ein Delir ist mit einer verlängerten Beatmungsdauer, einer verlängerten Krankenhausverweildauer, erhöhten Komplikationsraten, wie nosokomialen Infektionen, und einer erhöhten Mortalität assoziiert. Maßnahmen zur verbesserten Diagnostik und Behandlung können nur erfolgreich sein, wenn Ärzte, Pflegekräfte und medizinisches Personal eng zusammenarbeiten und Strategien gemeinsam umsetzen.

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Literatur

  1. Sass H, Wittchen HU, Zaudig M, Houben I (2003) Diagnostische Kriterien DSM-IV-TR. Hogrefe, Göttingen

    Google Scholar 

  2. WHO (1990) The ICD-10 Classification of mental and behavioral disorder, diagnostic criteria for research. WHO, Genf

    Google Scholar 

  3. Laurila JV, Pitkala KH, Strandberg TE, Tilvis RS (2004) Impact ofdiffe- rent diagnostic criteria on prognosis of delirium: a prospective study. Dement GeriatrCogn Disord 18:24024–4

    Google Scholar 

  4. Pandharipande P, Cotton BA, Shintani A et al (2007) Motoric Subtypes of delirium in mechanical- ly ventilated surgical and trauma intensive care unit patients. Intensive CareMed 33:1726–1731

    Google Scholar 

  5. Ouimet S, Riker R, Bergeron N et al (2007) Subsyndromal delirium in the ICU: evidence for a disease spectrum. Intensive Care Med 33:1007101–3

    Google Scholar 

  6. Cole M, McCusker J, Dendukuri N, Han L (2003) The prognostic signi- ficance of subsyndromal delirium in elderly medical inpatients. J Am Geriatr Soc 51:754–760

    Article  PubMed  Google Scholar 

  7. Cole MG, YouY, McCusker Jet al (2008) The 6 and 12 month outco- mes of older medical inpatients who recover from delirium. Int J Geriatr Psychiatry 23:301–307

    Article  PubMed  Google Scholar 

  8. Sprung CL, Peduzzi PN, Shatney CH etal (1990) Impact ofencephalo- pathy on mortality in the sepsis Syndrome. The Veterans Administration Systemic Sepsis Cooperative Study Group. Crit Care Med 18:801 –806

    Article  PubMed  CAS  Google Scholar 

  9. Martin BJ, Buth KJ, Arora RC, Bas- kett RJ (2010) Delirium as a predictor of sepsis in post-coronary artery by- pass grafting patients: a retrospecti- ve cohort study. Crit Care 14:R171

    Article  PubMed  Google Scholar 

  10. lacobone E, Bailiy-Salin J, Polito A et al (2009) Sepsis-associated encepha- lopathy and its differential diagnosis. Crit Care Med 37:331–336

    Google Scholar 

  11. Ely EW, Inouye SK, Bernard GR et al (2001) Delirium in mechanically ventilated patients: validity and relia- bility of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 286:2703–2710

    Article  PubMed  Google Scholar 

  12. Ely EW, Gautam S, Margolin R et al (2001) The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med 27:1892–1900

    PubMed  Google Scholar 

  13. Ely EW, Shintani A, Truman B etal (2004) Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 291:1753–1762

    Article  PubMed  Google Scholar 

  14. Lin SM, Huang CD, Liu CY et al (2008) Risk factors for the development of early-onset delirium and the subse- quent clinical outcome in mechanically ventilated patients. J Crit Care 23:372–379

    Article  PubMed  Google Scholar 

  15. Kat MG, Vreeswijk R, Jonghe JF de et al (2008) Long-term cognitive outcome of delirium in elderly hip surge- ry patients. A prospective matched controlled study overtwo and a half years. Dement Geriatr Cogn Disord 26:1–8

    Article  PubMed  Google Scholar 

  16. Pisani MA, Kong SY, Kasl SV et al (2009) Days of delirium are associated with 1 -year mortality in an older intensive care unit population. Am J Respir Crit Care Med 180:1092–1097

    Article  PubMed  Google Scholar 

  17. Inouye SK, Charpentier PA (1996) Precipitating factors for delirium in hospitalized elderly persons. Pre- dictive model and interrelationship with baseline vulnerability. JAMA 275:852–857

    Article  PubMed  Google Scholar 

  18. Radtke FM, Franck M, MacGuill M et al (2010) Duration of fluid fasting and choice of analgesic are modifia- ble factors for early postoperative delirium. Eur J Anaesthesiol 27:411 - 41619. Ancelin ML, Artero S, Portet F et al (2006) Non-degenerative mild cog- nitive impairment in elderly peo- ple and use of anticholinergic drugs: longitudinal cohort study. BMJ 332:455–459

    Google Scholar 

  19. Gool WA van, Beek D van de, Eike- lenboom P (2010) Systemic infec- tion and delirium: when cytokines and acetylcholine collide. Lancet 375:773–775

    Google Scholar 

  20. Novaes MA, Aronovich A, Ferraz MB, Knobel E (1997) Stressors in ICU: patients' evaluation. Intensive Care Med 23:1282–1285

    Article  PubMed  Google Scholar 

  21. Nie H, Zhao B, Zhang YQ et al (2011) Pain and cognitive dysfunction are the risk factors of delirium in elderly hip fracture Chinese patients. Arch Gerontol Geriatr 54(2):e172-e174

    Article  PubMed  Google Scholar 

  22. Young J, Murthy L, Westby M et al (2010) Diagnosis, prevention, and management of delirium: summary of NICE guidance. BMJ 341 :c3704

    Article  PubMed  Google Scholar 

  23. Jacobi J, Fräser GL, Coursin DB et al (2002) Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 30:119–141

    PubMed  Google Scholar 

  24. Martin J, Heymann A, Bäsell K et al (2010) Evidenceand consensus-ba- sed German guidelines for the management of analgesia, sedation and delirium in intensive care - short Version. Ger Med Sei 8:Doc02

    Google Scholar 

  25. Devlin JW, Marquis F, Riker RR et al (2008) Combined didactic and sce- nario-based education improves the ability of intensive care unit staffto recognize delirium at the bedside. Crit Care 12:R19

    Article  PubMed  Google Scholar 

  26. Guenther U, Popp J, Koecher L et al (2010) Validity and reliability of the CAM-ICU flowsheet to diagnose delirium in surgical ICU patients. J Crit Care 25:144–151

    Article  PubMed  Google Scholar 

  27. Radtke FM, Franck M, Oppermann S et al (2009) The intensive care delirium Screening checklist (ICDSC) - translation and Validation of intensive care delirium checklist in accor- dance with guidelines. Anasthesi- ol Intensivmed Notfallmed Schmerz- ther 44:80–86

    Google Scholar 

  28. Lütz A, Radtke FM, Franck M et al (2008) The nursing delirium Screening scale (NU-DESC). Anasthesiol Intensivmed Notfallmed Schmerz- ther 43:98–102

    Google Scholar 

  29. Sander M, Neumann T, DossowV von et al (2006) Alcohol use disorder: risks in anesthesia and intensive care medicine. Internist (Berl) 47:332, 334-336,33–8

    Google Scholar 

  30. Lütz A, Heymann A, Radtke FM, Spies CD (2010) If delirium is not moni- tored it will often be not detected. Anasthesiol Intensivmed Notfallmed Schmerzther 45:106–111

    Article  PubMed  Google Scholar 

  31. Luetz A, Heymann A, Radtke FM et al (2010) Different assessment tools for intensive care unit delirium: which score to use? Crit Care Med 38:40941–8

    Google Scholar 

  32. Plaschke K, Haken R von, Scholz M et al (2008) Comparison of the confusi- on assessment method for the intensive care unit (CAM-ICU) with the intensive care delirium Screening checklist (ICDSC) for delirium in critical care patients gives high agreement rate(s). Intensive Care Med 34:43143–6

    Article  Google Scholar 

  33. Girard TD, Kress JP, Fuchs BD et al (2008) Efficacy and safety of a pai- red sedation and Ventilator weaning protoeol for mechanically ventilated patients in intensive care (awake- ning and breathing controlled trial): a randomised controlled trial. Lancet 371:126–134

    PubMed  Google Scholar 

  34. Ely EW, Truman B, Shintani A et al (2003) Monitoring sedation status overtime in ICU patients: reliability and validity of the Richmond agi- tation-sedation scale (RASS). JAMA 289:2983–2991

    Article  PubMed  Google Scholar 

  35. Ouimet S, Kavanagh BP, Gottfried SB, SkrobikY (2007) Incidence, risk factors and consequences of ICU delirium. Intensive Care Med 33:66–73

    PubMed  Google Scholar 

  36. Whipple JK, Lewis KS, Quebbeman EJ et al (1995) Analysis of pain management in critically ill patients. Pharmacotherapy 15:592–599

    PubMed  Google Scholar 

  37. PayenJF, ChanquesG, MantzJetal (2007) Current practices in sedation and analgesia for mechanically ventilated critically ill patients: a pro- spective multicenter patient-based study. Anesthesiology 106:687-695, 891–892

    Google Scholar 

  38. Chanques G, Viel E, Constantin JM et al (2010) The measurement of pain in intensive care unit: comparison of 5 self-report intensity scales. Pain 151:711–721

    Article  PubMed  Google Scholar 

  39. Payen JF, Bru 0, Bosson JL et al (2001) Assessing pain in critically ill sedated patients by using a be- havioral pain scale. Crit Care Med 29:2258–2263

    Google Scholar 

  40. Chanques G, Payen JF, Mercier G et al (2009) Assessing pain in non-intuba- ted critically ill patients unable to seif report: an adaptation of the beha- vioral pain scale. Intensive Care Med 35:2060–2067

    PubMed  Google Scholar 

  41. Mistarz R, Eliott S, Whitfield A, Ernest D (2011) Bedside nurse-patient in- teractions do not reliably detect delirium: an observational study. Aust Crit Care 24:126–132

    Article  PubMed  Google Scholar 

  42. McCuskerJ, ColeMG, VoyerPetal (2011) Use of nurse-observed symptoms of delirium in long-term care: effects on prevalence and outco- mes of delirium. Int Psychogeriatr 23:602–608

    Google Scholar 

  43. Heymann A, Radtke F, Schiemann A etal (2010) Delayed treatmentof delirium increases mortality rate in intensive care unit patients. J Int Med Res 38:1584–1595

    PubMed  Google Scholar 

  44. Girard TD, Pandharipande PP, Carson SS et al (2010) Feasibility, efficacy, and safety of antipsychotics for intensive care unit delirium: the MIND randomized, placebo-controlled trial. Crit Care Med 38:428–437

    PubMed  Google Scholar 

  45. Kalisvaart KJ, Jonghe JF de, Bogaards MJ et al (2005) Haloperidol Prophylaxis for elderly hip-surgery patients at risk for delirium: a randomized pla- cebo-controlled study. J Am Geriatr Soc 53:1658–1666

    Article  PubMed  Google Scholar 

  46. Meyer-Massetti C, Cheng CM, Shar- pe BA et al (2010) The FDA extended warning for intravenous haloperidol and torsades de pointes: how should institutions respond? J Hosp Med 5:E8–16

    Article  Google Scholar 

  47. Spies CD, Rommelspacher H (1999) Alcohol withdrawal in the surgical patient: prevention and treatment. Anesth Anaig 88:946–954

    Google Scholar 

  48. Spies CD, Otter HE, Hüske B et al (2003) Alcohol withdrawal severity is decreased by symptom-orientated adjusted bolus therapy in the ICU. Intensive Care Med 29:2230–2238

    Article  PubMed  Google Scholar 

  49. Lonergan E, Luxenberg J, Areosa Sas- tre A, WyllerTB (2009) Benzodiazepines for delirium. Cochrane Database Syst Rev 4:CD006379

    PubMed  Google Scholar 

  50. Pandharipande P, Shintani A, Peterson J et al (2006) Lorazepam is an independent risk factor for tran- sitioning to delirium in intensive care unit patients. Anesthesiology 104:21–26

    Article  PubMed  Google Scholar 

  51. PisaniMA, MurphyTE, AraujoKLet al (2009) Benzodiazepine and opioid use and the duration of intensive care unit delirium in an older population. Crit Care Med 37:177–183

    Google Scholar 

  52. Lütz A, Spies C (2011) ICU delirium - consequences for management of analgesia and sedation in the critically ill. Anasthesiol Intensivmed Notfallmed Schmerzther 46:568–572

    PubMed  Google Scholar 

  53. Pandharipande PP, Pun BT, Herr DL et al (2007) Effect of sedation with dex- medetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA 298:2644–2653

    Article  PubMed  Google Scholar 

  54. Reade MC, O'Sullivan K, Bates S et al (2009) Dexmedetomidine vs. haloperidol in delirious, agitated, intuba- ted patients: a randomised open-la- bel trial. Crit Care13:R75

    Google Scholar 

  55. American Psychiatric Association (1999) Practice guideline for the treatment of patients with delirium. Am JPsychiatry 156:1–20

    Google Scholar 

  56. Lundström M, Edlund A, Karlsson S et al (2005) A multifactorial Intervention program reduces the duration of delirium, length of hospitalization, and mortality in delirious patients. J Am Geriatr Soc 53:622–628

    PubMed  Google Scholar 

  57. Morandi A, Brummel NE, Ely EW (2011) Sedation, delirium and me- chanical Ventilation: the, ABCDE' ap- proach. Curr Opin Crit Care 17(1 ):43- 4–9

    Google Scholar 

  58. Luetz A, Goldmann A, Weber-Carstens S, Spies C (2012) Weaning from mechanical Ventilation and sedation. Curr Opin Anaesthesiol 25(2):164- 16–9

    Google Scholar 

  59. SkrobikY, Ahern S, Leblanc M et al (2010) Protocolized intensive care unit management of analgesia, sedation, and delirium improves analgesia and subsyndromal delirium rates. Anesth Anaig 111:451–463

    Google Scholar 

  60. King MS, Render ML, Ely EW, Watson PL (2010) Liberation and animation: strategies to minimize brain dysfunction in critically ill patients. Semin Respir Crit Care Med 31:87–96

    Article  PubMed  Google Scholar 

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Luetz, A., Weiss, B., Held, H., Spies, C. (2013). Das Delir auf Intensivstationen. In: Janssens, U., Joannidis, M., Mayer, A. (eds) Weiterbildung Intensivmedizin und Notfallmedizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-40738-3_4

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  • DOI: https://doi.org/10.1007/978-3-642-40738-3_4

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