Delir: verstehen, vermeiden und behandeln

Bei älteren Patienten kommt es im Rahmen eines stationären Aufenthalts oftmals – vor allem nach operativen Eingriffen – zum Delir. Dieser Beitrag soll Impulse für die praxisnahe Umsetzung des perioperativen nichtpharmakologischen Delirmanagements vermitteln.

• Literatur

• 1 Aldecoa C, Bettelli G, Bilotta F. et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol 2017; 34: 192-214
• 2 American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults. American Geriatrics Society abstracted clinical practice guideline for postoperative delirium in older adults. J Am Geriatr Soc 2015; 63: 142-150
• 3 Müller DA, Markewitz PDA, Waydhas PDC. et al. S3-Leitlinie Analgesie, Sedierung und Delir-Management in der Intensivmedizin (DAS-Leitlinie). 2021 Im Internet https://register.awmf.org/de/leitlinien/detail/001-012 Stand: 16.01.2025
• 4 Lauffer-Vogt SU, Hediger H, Lauener SK, Schubert M. Anwendung der DOS und Delirprävalenz: Eine quantitative Längsschnittstudie in einem Schweizer Zentrumsspital. Pflege 2024; 37: 89-97
• 5 Jin Z, Hu J, Ma D. Postoperative delirium: Perioperative assessment, risk reduction, and management. Br J Anaesth 2020; 125: 492-504
• 6 Radtke FM, Franck M, MacGuill M. et al. Duration of fluid fasting and choice of analgesic are modifiable factors for early postoperative delirium. Eur J Anaesthesiol 2010; 27: 411-416
• 7 Deeken F, Sánchez A, Rapp MA. et al. Outcomes of a delirium prevention program in older persons after elective surgery. JAMA Surg 2022; 157: e216370
• 8 Hshieh TT, Yue J, Oh E. et al. Effectiveness of multicomponent nonpharmacological delirium interventions: A meta-analysis. JAMA Intern Med 2015; 175: 512-520
• 9 Wang YY, Yue JR, Xie DM. et al. Effect of the tailored, family-involved hospital elder life program on postoperative delirium and function in older adults: A randomized clinical trial. JAMA Intern Med 2020; 180: 17-25
• 10 Pun BT, Balas MC, Barnes-Daly MA. et al. Caring for critically ill patients with the ABCDEF bundle: Results of the ICU liberation collaborative in over 15,000 adults. Crit Care Med 2019; 47: 3-14
• 11 Maldonado JR. Delirium pathophysiology: An updated hypothesis of the etiology of acute brain failure. Int J Geriatr Psychiatr 2018; 33: 1428-1457
• 12 Pavone KJ, Cacchione PZ, Polomano RC. et al. Evaluating the use of dexmedetomidine for the reduction of delirium: An integrative review. Heart & Lung 2018; 47: 591-601
• 13 Vasiljewa L, Müller A, Spies C. Pharmakologische Behandlung des postoperativen Delirs. Anästhesiol Intensivmed Notfallmed Schmerzther 2023; 58: 513-524
• 14 Ahrens E, Tartler TM, Suleiman A. et al. Dose-dependent relationship between intra-procedural hypoxaemia or hypocapnia and postoperative delirium in older patients. Br J Anaesth 2023; 130: e298-e306
• 15 Chu Z, Wu Y, Dai X. et al. The risk factors of postoperative delirium in general anesthesia patients with hip fracture. Medicine (Baltimore) 2021; 100: e26156
• 16 Kupiec A, Adamik B, Forkasiewicz-Gardynik K. et al. Intra-operative hyperoxia and the risk of delirium in elderly patients after cardiac surgery. Ageing 2020; 12: 7006-7014
• 17 Potharajaroen S, Tangwongchai S, Tayjasanant T. et al. Bright light and oxygen therapies decrease delirium risk in critically ill surgical patients by targeting sleep and acid-base disturbances. Psychiatr Res 2018; 261: 21-27
• 18 National Institute for Health and Care Excellence (NICE). Delirium: Prevention, diagnosis and management in hospital and long-term care. Guideline 2023 Im Internet www.nice.org.uk/guidance/cg103 Stand: 16.01.2025
• 19 Nydahl P, Jeitziner MM, Vater V. et al. Early mobilisation for prevention and treatment of delirium in critically ill patients: Systematic review and meta-analysis. Intensive Crit Care Nurs 2023; 74: 103334
• 20 TEAM Study Investigators and the ANZICS Clinical Trials Group. Hodgson CL, Bailey M, Bellomo R. et al. Early active mobilization during mechanical ventilation in the ICU. N Engl J Med 2022; 387: 1747-1758
• 21 Malenbaum S, Keefe FJ, de Williams AC. et al. Pain in its environmental context: Implications for designing environments to enhance pain control. Pain 2008; 134: 241-244
• 22 Maurice-Szamburski A, Auquier P, Viarre-Oreal V. et al. Effect of sedative premedication on patient experience after general anesthesia. JAMA 2015; 313: 916
• 23 Seemann M, Zech N, Graf B. et al. Das Prämedikationsgespräch: Anregungen zu einer patientenfreundlichen Gestaltung. Anästhesiol Intensivmed Notfallmed Schmerzther 2015; 50: 142-146
• 24 Zem AJ, Nowicka-Sauer K, Jarmoszewicz K. et al. Measures of preoperative anxiety. Anesthesiol Intensive Ther 2019; 51: 64-69
• 25 Saravana-Bawan B, Warkentin LM, Rucker D. et al. Incidence and predictors of postoperative delirium in the older acute care surgery population: A prospective study. Can J Surg 2019; 62: 33-38
• 26 Adams AMN, Chamberlain D, Grønkjær M. et al. Nonpharmacological interventions for agitation in the adult intensive care unit: A systematic review. Aust Crit Care 2023; 36: 385-400
• 27 Knauert MP, Ayas NT, Bosma KJ. et al. Causes, consequences, and treatments of sleep and circadian disruption in the ICU: An official American thoracic society research statement. Am J Respir Crit Care Med 2023; 207: e49-e68
• 28 Jaiswal S, Garcia S, Owens R. Sound and light levels are similarly disruptive in ICU and non-ICU wards. J Hospital Med 2017; 12: 798-804
• 29 Weidner E, Hancke L, Nydahl P. et al. Nicht pharmakologisches Management des postoperativen Delirs. Anästhesiol Intensivmed Notfallmed Schmerzther 2023; 58: 494-512
• 30 He E, Dong Y, Jia H. et al. Relationship of sleep disturbance and postoperative delirium: A systematic review and meta-analysis. Gland Surg 2022; 11: 1192-1203
• 31 Schmidt S, Hancke L, Haussmann R. et al. Chronobiological interventions for prevention and treatment of delirium in critically ill patients. Nervenarzt 2022; 93: 901-911
• 32 Luetz A, Grunow JJ, Mörgeli R. et al. Innovative ICU solutions to prevent and reduce delirium and post Intensive Care Unit syndrome. Semin Respir Crit Care Med 2019; 40: 673-686
• 33 Kotfis K, van Diem-Zaal I, Roberson SW. et al. The future of intensive care: Delirium should no longer be an issue. Crit Care 2022; 26: 200
• 34 Yürek F, Marschall U, Gaedigk U. et al. Qualitätsvertrag zur Prävention des postoperativen Delirs. Anästhesiol Intensivmed Notfallmed Schmerzther 2023; 58: 525-539