Psychosoziale Betreuung auf der Intensivstation

Für die meisten Patient*innen und ihre Angehörigen ist die intensivmedizinische Behandlung mit einem immensen Stress, aber auch späteren körperlichen, psychischen und kognitiven Beeinträchtigungen – dem Post-Intensive-Care-Syndrom – verbunden. Ziele der psychosozialen Unterstützung auf der Intensivstation sind die Stabilisierung und Minimierung der Akutbelastung für Patient*innen, Angehörige und auch das Behandlungsteam.

Abstract

The improvement of intensive care treatment options leads to an increasing number of patients being treated in this setting. For the majority of those affected and their relatives, this treatment is associated with tremendous stress, but also subsequent physical, psychological and cognitive impairments, the post-intensive care syndrome. The aim of psychosocial support in the intensive care unit is to stabilise and minimise the acute stress. This is done through care services oriented towards trauma therapy interventions and emergency psychology. Equally central are the needs of the patient’s relatives and ways to stabilise and relieve them. The third pillar of psychosocial work in the intensive care unit is the support of the treatment team. Finally, an outlook is given for the specialised aftercare of these complex patients in PICS outpatient clinics.

Kernaussagen

• Die Verbesserung intensivmedizinischer Behandlungsmöglichkeiten führt zu einer zunehmenden Zahl von Patient*innen, die in diesem Setting behandelt werden.

• Für die Mehrzahl der Betroffenen und ihrer Angehörigen ist die ITS-Behandlung mit einem immensen Stress, aber auch späteren körperlichen, psychischen und kognitiven Beeinträchtigungen – dem Post-Intensive-Care-Syndrom – verbunden.

• Ziel der psychosozialen Unterstützung auf der Intensivstation ist die Stabilisierung und Minimierung der Akutbelastung für die Patient*innen. Dies erfolgt durch Betreuungsangebote, die sich an traumatherapeutischen Interventionen und Notfallpsychologie orientieren.

• Ebenso zentral sind die Bedürfnisse der Angehörigen und Möglichkeiten deren Stabilisierung und Entlastung.

• Als wesentliche dritte Säule der psychosozialen Arbeit auf der Intensivstation gilt die Unterstützung des Behandlungsteams.

• Eine spezialisierte Nachsorge dieser komplexen Patient*innen erfolgt in PICS-Ambulanzen.

Schlüsselwörter

psychosoziale Betreuung - Stressbewältigung - Zugehörigenbetreuung - Teamunterstützung - intensivmedizinische Nachsorge

Keywords

psychosocial care - stress management - care for relatives - team support - intensive medical aftercare

Publication History

Article published online:
06 December 2023

• Literatur

• 1 Kaukonen KM, Bailey M, Suzuki S. et al. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000–2012. JAMA 2014; 311: 1308-1316 DOI: 10.1001/jama.2014.2637. (PMID: 24638143)
• 2 Paul N, Albrecht V, Denke C. et al. A Decade of Post-Intensive Care Syndrome: A Bibliometric Network Analysis. Medicina (Kaunas) 2022; 58: 170 DOI: 10.3390/medicina58020170. (PMID: 35208494)
• 3 Lampart M, Rüegg M, Jauslin AS. et al. Direct Comparison of Clinical Characteristics, Outcomes, and Risk Prediction in Patients with COVID-19 and Controls – A Prospective Cohort Study. J Clin Med 2021; 10: 2672 DOI: 10.3390/jcm10122672. (PMID: 34204453)
• 4 Stang A, Stang M, Jockel KH. Estimated Use of Intensive Care Beds Due to COVID-19 in Germany Over Time. Dtsch Arztebl Int 2020; 117: 329-335 DOI: 10.3238/arztebl.2020.0329. (PMID: 32527378)
• 5 Dziadzko V, Dziadzko MA, Johnson MM. et al. Acute psychological trauma in the critically ill: Patient and family perspectives. Gen Hosp Psychiatry 2017; 47: 68-74 DOI: 10.1016/j.genhosppsych.2017.04.009. (PMID: 28807140)
• 6 Kohler J, Borchers F, Endres M. et al. Cognitive Deficits Following Intensive Care. Dtsch Arztebl Int 2019; 116: 627-634 DOI: 10.3238/arztebl.2019.0627. (PMID: 31617485)
• 7 Kang J, Yun S, Hong J. Health-related quality of life measured with the EQ-5D-5L in critical care survivors: A cross-sectional study. Intensive Crit Care Nurs 2022; 72: 103252 DOI: 10.1016/j.iccn.2022.103252. (PMID: 35396103)
• 8 Turnbull AE, Ji H, Dinglas VD. et al. Understanding Patients’ Perceived Health After Critical Illness: Analysis of Two Prospective, Longitudinal Studies of ARDS Survivors. Chest 2022; 161: 407-417 DOI: 10.1016/j.chest.2021.07.2177. (PMID: 34419426)
• 9 Gerth AMJ, Hatch RA, Young JD. et al. Changes in health-related quality of life after discharge from an intensive care unit: a systematic review. Anaesthesia 2019; 74: 100-108 DOI: 10.1111/anae.14444. (PMID: 30291744)
• 10 Miyamoto Y, Ohbe H, Goto T. et al. Association between intensive care unit admission of a patient and mental disorders in the spouse: a retrospective matched-pair cohort study. J Intensive Care 2021; 9: 69 DOI: 10.1186/s40560-021-00583-3. (PMID: 34715945)
• 11 Niecke A, Schneider G, Hartog CS. et al. [Traumatized relatives of intensive care patients]. Med Klin Intensivmed Notfmed 2017; 112: 612-617 DOI: 10.1007/s00063-017-0316-7. (PMID: 28707029)
• 12 Krampe H, Denke C, Gülden J. et al. Perceived Severity of Stressors in the Intensive Care Unit: A Systematic Review and Semi-Quantitative Analysis of the Literature on the Perspectives of Patients, Health Care Providers and Relatives. J Clin Med 2021; 10: 3928 DOI: 10.3390/jcm10173928. (PMID: 34501376)
• 13 Needham DM, Davidson J, Cohen H. et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference. Crit Care Med 2012; 40: 502-509 DOI: 10.1097/CCM.0b013e318232da75. (PMID: 21946660)
• 14 Parker AM, Sricharoenchai T, Raparla S. et al. Posttraumatic stress disorder in critical illness survivors: a metaanalysis. Crit Care Med 2015; 43: 1121-1129 DOI: 10.1097/CCM.0000000000000882. (PMID: 25654178)
• 15 Nikayin S, Rabiee A, Hashem MD. et al. Anxiety symptoms in survivors of critical illness: a systematic review and meta-analysis. Gen Hosp Psychiatry 2016; 43: 23-29 DOI: 10.1016/j.genhosppsych.2016.08.005. (PMID: 27796253)
• 16 Rabiee A, Nikayin S, Hashem MD. et al. Depressive Symptoms After Critical Illness: A Systematic Review and Meta-Analysis. Crit Care Med 2016; 44: 1744-1753 DOI: 10.1097/CCM.0000000000001811. (PMID: 27153046)
• 17 Sasannejad C, Ely EW, Lahiri S. Long-term cognitive impairment after acute respiratory distress syndrome: a review of clinical impact and pathophysiological mechanisms. Crit Care 2019; 23: 352 DOI: 10.1186/s13054-019-2626-z. (PMID: 31718695)
• 18 Rousseau AF, Prescott HC, Brett SJ. et al. Long-term outcomes after critical illness: recent insights. Crit Care 2021; 25: 108 DOI: 10.1186/s13054-021-03535-3. (PMID: 33731201)
• 19 Geense WW, Zegers M, Peters MAA. et al. New Physical, Mental, and Cognitive Problems 1 Year after ICU Admission: A Prospective Multicenter Study. Am J Respir Crit Care Med 2021; 203: 1512-1521 DOI: 10.1164/rccm.202009-3381OC. (PMID: 33526001)
• 20 Inoue S, Hatakeyama J, Kondo Y. et al. Post-intensive care syndrome: its pathophysiology, prevention, and future directions. Acute Med Surg 2019; 6: 233-246 DOI: 10.1002/ams2.415. (PMID: 31304024)
• 21 Petrinec A, Wilk C, Hughes JW. et al. Delivering Cognitive Behavioral Therapy for Post-Intensive Care Syndrome-Family via a Mobile Health App. Am J Crit Care 2021; 30: 451-458 DOI: 10.4037/ajcc2021962. (PMID: 34719716)
• 22 Deffner T, Michels G, Nojack A. et al. [Psychological care in the intensive care unit : Task areas, responsibilities, requirements, and infrastructure]. Med Klin Intensivmed Notfmed 2020; 115: 205-212 DOI: 10.1007/s00063-018-0503-1. (PMID: 30367190)
• 23 Cag Y, Erdem H, Gormez A. et al. Anxiety among front-line health-care workers supporting patients with COVID-19: A global survey. Gen Hosp Psychiatry 2021; 68: 90-96 DOI: 10.1016/j.genhosppsych.2020.12.010. (PMID: 33418193)
• 24 Gualano MR, Sinigaglia T, Lo Moro G. et al. The Burden of Burnout among Healthcare Professionals of Intensive Care Units and Emergency Departments during the COVID-19 Pandemic: A Systematic Review. Int J Environ Res Public Health 2021; 18: 8172 DOI: 10.3390/ijerph18158172.
• 25 Hodkinson A, Zhou A, Johnson J. et al. Associations of physician burnout with career engagement and quality of patient care: systematic review and meta-analysis. BMJ 2022; 378: e070442 DOI: 10.1136/bmj-2022-070442.
• 26 Strauß B. Psychologische Modelle für die Intensivmedizin – Definitionen, Leitlinienempfehlungen und strukturelle Grundlagen. In: Deffner T, Strauß B. Praxisbuch Psychologie in der Intensiv- und Notfallmedizin: Konzepte für die psychosoziale Versorgung kritisch kranker Patienten und ihrer Angehörigen. Berlin: Medizinisch Wissenschaftliche Verlagsgesellschaft; 2022
• 27 Gündel H. IPS-Pilot – Integrierte Psychosoziale Versorgung in der Intensivmedizin: Partizipative Entwicklung und Pilotierung eines innovativen Versorgungsansatzes. Gemeinsamer Bundesausschuss Innovationsausschuss. Accessed October 12, 2023 at: https://innovationsfonds.g-ba.de/projekte/versorgungsforschung/ips-pilot-integrierte-psychosoziale-versorgung-in-der-intensivmedizin-partizipative-entwicklung-und-pilotierung-eines-innovativen-versorgungsansatzes.530
• 28 Hillmann B, Schwarzkopf D, Manser T. et al. Structure and concept of ICU rounds: the VIS-ITS survey. Med Klin Intensivmed Notfmed 2022; 117: 276-282 DOI: 10.1007/s00063-021-00830-3. (PMID: 34125258)
• 29 Deffner T. Clinical psychology in the intensive care unit – A conceptual framework. Anästh Intensivmed 2017; 58: 248-258
• 30 Deffner T, Schwarzkopf D, Waydhas C. [Psychological care in German intensive care units: Results of a survey among the members of the German Interdisciplinary Association for Intensive Care and Emergency Medicine]. Med Klin Intensivmed Notfmed 2021; 116: 146-153 DOI: 10.1007/s00063-019-00638-2. (PMID: 31781828)
• 31 Meraner V, Sperner-Unterweger B. [Patients, physicians and nursing personnel in intensive care units: Psychological and psychotherapeutic interventions]. Nervenarzt 2016; 87: 264-268 DOI: 10.1007/s00115-016-0098-9. (PMID: 26927678)
• 32 Glaesmer H, Rosendahl J. Traumatisierung im Kontext schwerer körperlicher und medizinischer Behandlungen. In: Seidler GH, Glaesmer H, Gahleitner SB. Handbuch der Psychotraumatologie. Stuttgart: Klett-Cotta; 2019
• 33 Teufert SB. Psychosoziale Situation und psychologische Betreuung in der Intensivmedizin. In: Marks G, Muhl E, Zacharowski K. Die Intensivmedizin. Berlin, Heidelberg: Springer Medizin; 2019
• 34 Maercker A, Eberle D. Was bringt die ICD-11 im Bereich der trauma- und belastungsbezogenen Diagnosen?. Verhaltenstherapie 2022; 32: 1-10 DOI: 10.1159/000524958.
• 35 WHO. QE84: Acute stress reaction. ICD-11 for Mortality and Morbidity Statistics. 2023 Accessed October 12, 2023 at: https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f505909942
• 36 Shalev AY. Acute stress reactions in adults. Biol Psychiatry 2002; 51: 532-543 DOI: 10.1016/s0006-3223(02)01335-5. (PMID: 11950455)
• 37 Wade D, Hardy R, Howell D. et al. Identifying clinical and acute psychological risk factors for PTSD after critical care: a systematic review. Minerva Anestesiol 2013; 79: 944-963 (PMID: 23558761)
• 38 Huang M, Parker AM, Bienvenu OJ. et al. Psychiatric Symptoms in Acute Respiratory Distress Syndrome Survivors: A 1-Year National Multicenter Study. Crit Care Med 2016; 44: 954-965 DOI: 10.1097/CCM.0000000000001621. (PMID: 26807686)
• 39 Dilling H, Freyberger HJ, Cooper JE. Taschenführer zur ICD-10-Klassifikation psychischer Störungen: mit Glossar und Diagnostischen Kriterien sowie Referenztabellen ICD-10 vs. ICD-9 und ICD-10 vs. DSM-IV-TR : nach dem englischsprachigen Pocket Guide von J. E. Cooper/Weltgesundheitsorganisation. Bern: Hogrefe; 2019
• 40 Schweininger S, Forbes D, Creamer M. et al. The temporal relationship between mental health and disability after injury. Depress Anxiety 2015; 32: 64-71 DOI: 10.1002/da.22288. (PMID: 24995589)
• 41 King DA, Hussein E, Shochet GE. et al. Admission Rate of Patients With Major Psychiatric Disorders to the Intensive Care Unit. Am J Crit Care 2020; 29: 480-483 DOI: 10.4037/ajcc2020934. (PMID: 33130867)
• 42 Garcia RM. Psychiatric Disorders and Suicidality in the Intensive Care Unit. Crit Care Clin 2017; 33: 635-647 DOI: 10.1016/j.ccc.2017.03.005. (PMID: 28601138)
• 43 Hartog CS, Jöbges S, Kumpf O. et al. [Communicating with families in the ICU: Background and practical recommendations]. Med Klin Intensivmed Notfmed 2018; 113: 231-242 DOI: 10.1007/s00063-018-0417-y. (PMID: 29556682)
• 44 Beadman M, Carraretto M. Key elements of an evidence-based clinical psychology service within adult critical care. J Intensive Care Soc 2023; 24: 215-221 DOI: 10.1177/17511437211047178. (PMID: 37260428)
• 45 Cullberg J. Krisen und Krisentherapie. Psychiatrische Praxis 1978; 5: 25-34
• 46 Matt B, Schwarzkopf D, Reinhart K. et al. Relatives’ perception of stressors and psychological outcomes – Results from a survey study. J Crit Care 2017; 39: 172-177 DOI: 10.1016/j.jcrc.2017.02.03. (PMID: 28273613)
• 47 Meir Drexler S, Wolf OT. Behavioral disruption of memory reconsolidation: From bench to bedside and back again. Behav Neurosci 2018; 132: 13-22 DOI: 10.1037/bne0000231. (PMID: 29553773)
• 48 Netzer G, Sullivan DR. Recognizing, naming, and measuring a family intensive care unit syndrome. Ann Am Thorac Soc 2014; 11: 435-441 DOI: 10.1513/AnnalsATS.201309-308OT. (PMID: 24673699)
• 49 Shelton W, Moore CD, Socaris S. The effect of a family support intervention on family satisfaction, length-of-stay, and cost of care in the intensive care unit. Crit Care Med 2010; 38: 1315-1320 DOI: 10.1097/CCM.0b013e3181d9d9fe. (PMID: 20228678)
• 50 Davidson JE, Aslakson RA, Long AC. et al. Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU. Crit Care Med 2017; 45: 103-128 DOI: 10.1097/CCM.0000000000002169. (PMID: 27984278)
• 51 Hoffmann M, Nydahl P, Brauchle M. et al. [Ways of supporting relatives in intensive care units : Overview and update]. Med Klin Intensivmed Notfmed 2022; 117: 349-357 DOI: 10.1007/s00063-022-00915-7. (PMID: 35394164)
• 52 Deffner T, Rosendahl J, Niecke A. [Psychotraumatological aspects in intensive care medicine]. Med Klin Intensivmed Notfmed 2020; 115: 511-518 DOI: 10.1007/s00115-020-01060-2. (PMID: 33410960)
• 53 Wu AW. Medical error: the second victim. West J Med 2000; 172: 358-359 DOI: 10.1136/bmj.320.7237.726. (PMID: 10720336)
• 54 Strametz R, Raspe M, Ettl B. et al. [Recommended actions: Reinforcing clinicians’ resilience and supporting second victims during the COVID-19 pandemic to maintain capacity in the healthcare system]. Zentralbl Arbeitsmed Arbeitsschutz Ergon 2020; 70: 264-268
• 55 Embriaco N, Papazian L, Kentish-Barnes N. et al. Burnout syndrome among critical care healthcare workers. Curr Opin Crit Care 2007; 13: 482-488 DOI: 10.1097/MCC.0b013e3282efd28a. (PMID: 17762223)
• 56 Hartog CS. [Burnout – a call for action]. Med Klin Intensivmed Notfmed 2019; 114: 693-698 DOI: 10.1007/s00063-017-0362-1. (PMID: 29026930)
• 57 Niecke A, Niecke I. Supervision in der Intensivmedizin – Zwischen Fallarbeit und Teamentwicklung. In: Deffner T, Strauß B. Praxisbuch Psychologie in der Intensiv- und Notfallmedizin: Konzepte für die psychosoziale Versorgung kritisch kranker Patienten und ihrer Angehörigen. Berlin: Medizinisch Wissenschaftliche Verlagsgesellschaft; 2022: 303-306
• 58 Strametz R, Koch P, Vogelgesang A. et al. Prevalence of second victims, risk factors and support strategies among young German physicians in internal medicine (SeViD-I survey). J Occup Med Toxicol 2021; 16: 11 DOI: 10.1186/s12995-021-00300-8. (PMID: 33781278)
• 59 Brown SM, Bose S, Banner-Goodspeed V. et al. Approaches to Addressing Post-Intensive Care Syndrome among Intensive Care Unit Survivors. A Narrative Review. Ann Am Thorac Soc 2019; 16: 947-956 DOI: 10.1513/AnnalsATS.201812-913FR. (PMID: 31162935)
• 60 Maley JH, Mikkelsen ME. The Intersection of Health and Critical Illness: Preservation and Restoration. Am J Respir Crit Care Med 2021; 203: 1451-1453 DOI: 10.1164/rccm.202102-0306ED. (PMID: 33636093)
• 61 Jones C, Skirrow P, Griffiths RD. et al. Post-traumatic stress disorder-related symptoms in relatives of patients following intensive care. Intensive Care Med 2004; 30: 456-460 DOI: 10.1007/s00134-003-2149-5. (PMID: 14767589)
• 62 White C, Connolly B, Rowland MJ. Rehabilitation after critical illness. BMJ 2021; 373: n910 DOI: 10.1136/bmj.n910. (PMID: 33858835)
• 63 Schaller S, Paul N, Grunow J. et al. The Post-ICU Patient. Management of Long-Term Impairments After Critical Illness. ICU Management & Practice 2020; 20: 275-282
• 64 Schofield-Robinson OJ, Lewis SR, Smith AF. et al. Follow-up services for improving long-term outcomes in intensive care unit (ICU) survivors. Cochrane Database Syst Rev 2018; (11) CD012701
• 65 McPeake J, Boehm LM, Hibbert E. et al. Key Components of ICU Recovery Programs: What Did Patients Report Provided Benefit?. Crit Care Explor 2020; 2: e0088 DOI: 10.1097/CCE.0000000000000088. (PMID: 32426730)
• 66 Muradov O, Petrovskaya O, Papathanassoglou E. Effectiveness of cognitive interventions on cognitive outcomes of adult intensive care unit survivors: A scoping review. Austral Crit Care 2021; 34: 473-485 DOI: 10.1016/j.aucc.2020.11.001. (PMID: 33526331)
• 67 Haines KJ, Sevin CM, Hibbert E. et al. Key mechanisms by which post-ICU activities can improve in-ICU care: results of the international THRIVE collaboratives. Intensive Care Med 2019; 45: 939-947 DOI: 10.1007/s00134-019-05647-5. (PMID: 31165227)
• 68 King J, O’Neill B, Ramsay P. et al. Identifying Patients’ support needs following critical illness: a scoping review of the qualitative literature. Crit Care 2019; 23: 187 DOI: 10.1186/s13054-019-2441-6. (PMID: 31126335)
• 69 Pochard F, Azoulay E, Chevret S. et al. Symptoms of anxiety and depression in family members of intensive care unit patients: ethical hypothesis regarding decision-making capacity. Crit Care Med 2001; 29: 1893-1897 DOI: 10.1097/00003246-200110000-00007. (PMID: 11588447)
• 70 Davidson JE, Jones C, Bienvenu OJ. Family response to critical illness: postintensive care syndrome-family. Crit Care Med 2012; 40: 618-624 DOI: 10.1097/CCM.0b013e318236ebf9. (PMID: 22080636)
• 71 Petrinec AB, Martin BR. Post-intensive care syndrome symptoms and health-related quality of life in family decision-makers of critically ill patients. Palliat Support Care 2018; 16: 719-724 DOI: 10.1017/S1478951517001043. (PMID: 29277171)
• 72 Zante B, Camenisch SA, Schefold JC. Interventions in Post-Intensive Care Syndrome-Family: A Systematic Literature Review. Crit Care Med 2020; 48: e835-e840 DOI: 10.1097/CCM.0000000000004450. (PMID: 32590386)
• 73 Herridge MS, Azoulay É. Outcomes after Critical Illness. N Engl J Med 2023; 388: 913-924 DOI: 10.1056/NEJMra2104669. (PMID: 36884324)