Delir auf der Intensivstation

Ein Delir ist eine häufig vernachlässigte Manifestation von Organfunktionsstörungen, sowohl im perioperativen Setting als auch auf der Intensivstation. Oftmals bleibt es unentdeckt, da seine Manifestationsformen vielfältig sind. Die Erkennung eines Delirs im klinischen Alltag sowie gezielte therapeutische Interventionen stellen für viele Kliniker eine erhebliche Herausforderung dar. Dieser Beitrag beschäftigt sich mit der Definition, der Diagnosestellung und den Behandlungsoptionen eines Delirs.

Kernaussagen

• Das Delir ist eine häufige und schwerwiegende Komplikation bei älteren Patient*innen, insbesondere im perioperativen und intensivmedizinischen Kontext, die mit erhöhter Morbidität, Mortalität und längeren Krankenhausaufenthalten einhergeht.

• Die Diagnosestellung des Delirs basiert auf einer akuten und fluktuierenden Störung der Aufmerksamkeit sowie zusätzlichen kognitiven Beeinträchtigungen, die nicht durch andere neurokognitive Erkrankungen erklärbar sind.

• Eine frühzeitige Erkennung durch validierte Screening-Instrumente ist essenziell, um Komplikationen zu minimieren und die Prognose zu verbessern.

• Differenzialdiagnostisch müssen neurologische, metabolische, toxische und psychiatrische Ursachen sorgfältig abgeklärt werden, da sie ähnliche Symptome hervorrufen können.

• Die nicht-pharmakologische Therapie, insbesondere multimodale Maßnahmenbündel mit frühzeitiger Mobilisation, kognitiver Stimulation und Optimierung des Schlaf-Wach-Rhythmus, stellt den Behandlungsschwerpunkt dar, während medikamentöse Therapien nur symptomatisch und zurückhaltend eingesetzt werden sollten.

Schlüsselwörter

Delir - Intensivmedizin - Diagnostik - Therapie - Prävention

Publikationsverlauf

Artikel online veröffentlicht:
10. Oktober 2025

• Literatur

• 1 Pandharipande PP, Girard TD, Ely EW. Long-term cognitive impairment after critical illness. N Engl J Med 2014; 370: 185-186
• 2 Puntillo KA, Arai S, Cohen NH. et al. Symptoms experienced by intensive care unit patients at high risk of dying. Crit Care Med 2010; 38: 2155-2160
• 3 Brummel NE, Boehm LM, Girard TD. et al. Subsyndromal Delirium and Institutionalization Among Patients With Critical Illness. Am J Crit Care 2017; 26: 447-455
• 4 Ouimet S, Riker R, Bergeron N. et al. Subsyndromal delirium in the ICU: evidence for a disease spectrum. Intensive Care Med 2007; 33: 1007-1013
• 5 Ely EW, Shintani A, Truman B. et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 2004; 291: 1753-1762
• 6 Ely EW, Inouye SK, Bernard GR. et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 2001; 286: 2703-2710
• 7 Girard TD, Kress JP, Fuchs BD. et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet 2008; 371: 126-134
• 8 Bergeron N, Dubois MJ, Dumont M. et al. Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive Care Med 2001; 27: 859-864
• 9 Guenther U, Popp J, Koecher L. et al. Validity and reliability of the CAM-ICU Flowsheet to diagnose delirium in surgical ICU patients. J Crit Care 2010; 25: 144-151
• 10 Maldonado JR. Neuropathogenesis of delirium: review of current etiologic theories and common pathways. Am J Geriatr Psychiatry 2013; 21: 1190-1222
• 11 Ali S, Patel M, Jabeen S. et al. Insight into delirium. Innov Clin Neurosci 2011; 8: 25-34
• 12 Robinson TN, Raeburn CD, Angles EM. et al. Low tryptophan levels are associated with postoperative delirium in the elderly. Am J Surg 2008; 196: 670-674
• 13 Eggers V, Schilling A, Kox WJ. et al. [Septic encephalopathy. Diagnosis und therapy]. Anaesthesist 2003; 52: 294-303
• 14 Devlin JW, Skrobik Y, Gélinas C. et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med 2018; 46: e825-e873
• 15 Luetz A, Weiss B, Boettcher S. et al. Routine delirium monitoring is independently associated with a reduction of hospital mortality in critically ill surgical patients: A prospective, observational cohort study. J Crit Care 2016; 35: 168-173
• 16 AWMF. S3-Leitlinie: Analgesie, Sedierung und Delirmanagement in der Intensivmedizin (DAS-Leitlinie, 2020). Zugriff am 23. Juli 2025 unter: https://register.awmf.org/assets/guidelines/001-012l_S3_Analgesie-Sedierung-Delirmanagement-in-der-Intensivmedizin-DAS_2021-08.pdf
• 17 Luetz A, Balzer F, Radtke FM. et al. Delirium, sedation and analgesia in the intensive care unit: a multinational, two-part survey among intensivists. PLoS One 2014; 9: e110935
• 18 Weiss B, Paul N, Spies CD. et al. Influence of Patient-Specific Covariates on Test Validity of Two Delirium Screening Instruments in Neurocritical Care Patients (DEMON-ICU). Neurocrit Care 2022; 36: 452-462
• 19 Vincent JL, Shehabi Y, Walsh TS. et al. Comfort and patient-centred care without excessive sedation: the eCASH concept. Intensive Care Med 2016; 42: 962-971
• 20 Shehabi Y, Riker RR, Bokesch PM. et al. Delirium duration and mortality in lightly sedated, mechanically ventilated intensive care patients. Crit Care Med 2010; 38: 2311-2318
• 21 Shehabi Y, Chan L, Kadiman S. et al. Sedation depth and long-term mortality in mechanically ventilated critically ill adults: a prospective longitudinal multicentre cohort study. Intensive Care Med 2013; 39: 910-918
• 22 Olsen HT, Nedergaard HK, Strøm T. et al. Nonsedation or Light Sedation in Critically Ill, Mechanically Ventilated Patients. N Engl J Med 2020; 382: 1103-1111
• 23 Shehabi Y, Bellomo R, Reade MC. et al. Early intensive care sedation predicts long-term mortality in ventilated critically ill patients. Am J Respir Crit Care Med 2012; 186: 724-731
• 24 Treggiari MM, Romand JA, Yanez ND. et al. Randomized trial of light versus deep sedation on mental health after critical illness. Crit Care Med 2009; 37: 2527-2534
• 25 Balzer F, Weiß B, Kumpf O. et al. Early deep sedation is associated with decreased in-hospital and two-year follow-up survival. Crit Care 2015; 19: 197
• 26 Richman PS, Baram D, Varela M. et al. Sedation during mechanical ventilation: a trial of benzodiazepine and opiate in combination. Crit Care Med 2006; 34: 1395-1401
• 27 Spies C, Piazena H, Deja M. et al. Modification in ICU Design May Affect Delirium and Circadian Melatonin: A Proof of Concept Pilot Study. Crit Care Med 2024; 52: e182-e192
• 28 Felten M, Dame C, Lachmann G. et al. Circadian rhythm disruption in critically ill patients. Acta Physiol (Oxf) 2023; 238: e13962
• 29 Drewniok N, Kiselev J, Daum N. et al. Concepts for exercise therapy in prehabilitation for elderly people with frailty or pre-frailty prior to elective surgery. A scoping review. J Bodyw Mov Ther 2023; 36: 74-82
• 30 Daum N, Kiselev J, Schaller SJ. Der fraile Patient: fiktives Fallbeispiel. Anästhesiol Intensivmed Notfallmed Schmerzther 2022; 57: 674-681
• 31 Daum N, Hoff L, Spies C. et al. Influence of frailty status on the incidence of intraoperative hypotensive events in elective surgery: Hypo-Frail, a single-centre retrospective cohort study. Br J Anaesth 2025; 135: 40-47
• 32 Foster J, Kelly M. A pilot study to test the feasibility of a nonpharmacologic intervention for the prevention of delirium in the medical intensive care unit. Clin Nurse Spec 2013; 27: 231-238
• 33 Moon KJ, Lee SM. The effects of a tailored intensive care unit delirium prevention protocol: A randomized controlled trial. Int J Nurs Stud 2015; 52: 1423-1432
• 34 Rivosecchi RM, Kane-Gill SL, Svec S. et al. The implementation of a nonpharmacologic protocol to prevent intensive care delirium. J Crit Care 2016; 31: 206-211
• 35 Society of Critical Care Medicine (SCCM). ICU Liberation Bundle (A–F). Zugriff am 23. Juli 2025 unter: https://www.sccm.org/clinical-resources/iculiberation-home/abcdef-bundles
• 36 Balas MC, Devlin JW, Verceles AC. et al. Adapting the ABCDEF Bundle to Meet the Needs of Patients Requiring Prolonged Mechanical Ventilation in the Long-Term Acute Care Hospital Setting: Historical Perspectives and Practical Implications. Semin Respir Crit Care Med 2016; 37: 119-135
• 37 Daum N, Drewniok N, Bald A. et al. Early mobilisation within 72 hours after admission of critically ill patients in the intensive care unit: A systematic review with network meta-analysis. Intensive Crit Care Nurs 2024; 80: 103573
• 38 Lorenz M, Fuest K, Ulm B. et al. The optimal dose of mobilisation therapy in the ICU: a prospective cohort study. J Intensive Care 2023; 11: 56
• 39 Fuest KE, Ulm B, Daum N. et al. Clustering of critically ill patients using an individualized learning approach enables dose optimization of mobilization in the ICU. Crit Care 2023; 27: 1
• 40 Schaller SJ, Anstey M, Blobner M. et al. Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. Lancet 2016; 388: 1377-1388
• 41 Grunow JJ, Daum N, Langer N. et al. Mobilisation Matters: Strategies for Efficient Patient Care. ICU Manag Pract 2024; 24: 180-184
• 42 Collinsworth AW, Priest EL, Masica AL. Evaluating the Cost-Effectiveness of the ABCDE Bundle: Impact of Bundle Adherence on Inpatient and 1-Year Mortality and Costs of Care. Crit Care Med 2020; 48: 1752-1759
• 43 Barnes-Daly MA, Phillips G, Ely EW. Improving Hospital Survival and Reducing Brain Dysfunction at Seven California Community Hospitals: Implementing PAD Guidelines Via the ABCDEF Bundle in 6,064 Patients. Crit Care Med 2017; 45: 171-178
• 44 Schaller SJ, Grunow JJ, Daum N. et al. Übersicht S3-Leitlinie Lagerungstherapie und Mobilisation von kritisch Erkrankten auf Intensivstationen. Anästh Intensivmed 2025; 66: 126-139
• 45 Schaller SJ, Scheffenbichler FT, Bein T. et al. Guideline on positioning and early mobilisation in the critically ill by an expert panel. Intensive Care Med 2024; 50: 1211-1227
• 46 DIVI. Peer Review – Qualitätsindikatoren Intensivmedizin 2022, 4. Aufl.. Zugriff am 23. Juli 2025 unter: https://www.divi.de/joomlatools-files/docman-files/publikationen/peer-review/220310-qualitaetsindikatoren-intensivmedizin-divi-peer-review.pdf
• 47 Girard TD, Exline MC, Carson SS. et al. Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness. N Engl J Med 2018; 379: 2506-2516
• 48 Girard TD, Pandharipande PP, Ely EW. Delirium in the intensive care unit. Crit Care 2008; 12 (Suppl. 3) S3
• 49 Heymann A, Radtke F, Schiemann A. et al. Delayed treatment of delirium increases mortality rate in intensive care unit patients. J Int Med Res 2010; 38: 1584-1595
• 50 Wang HR, Woo YS, Bahk WM. Atypical antipsychotics in the treatment of delirium. Psychiatry Clin Neurosci 2013; 67: 323-331
• 51 Hughes CG, Boncyk CS, Culley DJ. et al. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Delirium Prevention. Anesth Analg 2020; 130: 1572-1590