Nicht pharmakologisches Management des postoperativen Delirs

Ein postoperatives Delir ist gerade bei älteren Patienten eine häufige Komplikation chirurgischer Eingriffe [1] [2]. Es erhöht Morbidität und Mortalität [1] [2] [3]. Strategien zum erfolgreichen Management des postoperativen Delirs sind nicht pharmakologische Multikomponentenmaßnahmen zur Risikoreduktion sowie Maßnahmen zur Früherkennung und Delir-Therapie. Dieser Beitrag soll Impulse für die praxisnahe Umsetzung des perioperativen nicht pharmakologischen Delir-Managements vermitteln.

Abstract

Postoperative delirium is common especially in the elderly and is associated with high rates of morbidity and mortality. Non-pharmacological multicomponent interventions are effective in reducing the incidence and to a degree the duration of postoperative delirium and are recommended in international guidelines on postoperative delirium as first line intervention for management of delirium. Non-pharmacological management of postoperative delirium consists of strategies for risk stratification, risk reduction by non-pharmacological bundle interventions, early recognition of delirium by screening protocols and immediate therapy of underlying causes of delirium and continuation of non-pharmacological bundles. Non-pharmacological bundle interventions address common perioperative risk factors. Bundles comprise strategies for oxygenation, mobilization, hydration and nutrition, sensory and cognitive stimulation, reorientation, modifications of environmental factors such as design aspects and noise reduction, adequate analgesia, management of agitation and anxiety, protecting circadian rhythms for example by adequate light exposure during daytime, family involvement and timely reduction of unnecessary catheters and anticholinergic drugs. The article aims at providing an overview of non-pharmacological management of postoperative delirium in the hospital.

Kernaussagen

• Das postoperative Delir gewinnt im klinischen Alltag aufgrund des demografischen Wandels und der damit verbunden zunehmenden perioperativen Versorgung älterer Patienten mit erhöhtem Delir-Risiko an Relevanz.

• Ein postoperatives Delir erhöht die Morbidität und Mortalität der betroffenen Patienten relevant. Die Therapie ist zeitkritisch, da ein prolongiertes Delir mit einem schlechteren Outcome assoziiert ist. Nicht pharmakologische Multikomponentenmaßnahmen können die Inzidenz und Dauer eines postoperativen Delirs effektiv reduzieren und werden in Leitlinien zum Management des postoperativen Delirs empfohlen.

• Das nicht pharmakologische Management des postoperativen Delirs besteht aus einer Risikostratifizierung zur Identifikation vulnerabler Patienten, Risikoreduktion durch nicht pharmakologische Multikomponentenmaßnahmen, Früherkennung durch strukturiertes Messen von Sedierung, Agitation, Delir und Schmerz und frühzeitiger Identifikation und Therapie der delirauslösenden Ursache sowie Intensivierung nicht pharmakologischer Maßnahmen.

• Nicht pharmakologische Multikomponentenmaßnahmen adressieren typische perioperative Risikofaktoren für ein Delir und vereinen Maßnahmen wie eine bedarfsorientierte Oxygenierung, Mobilisierung, Hydrierung und Ernährung, sensorische und kognitive Stimulierung, Reorientierung, Modifikation von Umgebungs- und Designfaktoren, ein effektives Schmerz-, Angst- und Agitationsmanagement, zirkadiane Rhythmisierung, Involvierung von Angehörigen und die kritische Indikationsstellung für einliegende Katheter und anticholinerge Medikamente.

• Das nicht pharmakologische Management des postoperativen Delirs setzt eine interdisziplinäre Zusammenarbeit des perioperativen Behandlungsteams sowie Implementierungsstrategien in die klinische Praxis voraus.

Schlüsselwörter

Intensivstation - Delir - Screening - Angst - Agitation - Sedierung - Lichttherapie - Umgebungsfaktoren

Keywords

intensive care unit - delirium - screening - agitation - anxiety - sedation - phototherapy - environmental factors

Publication History

Article published online:
19 September 2023

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