Analgesie, Sedierung und Delirmanagement – Die neue S3-Leitlinie „Analgesie, Sedierung und Delirmanagement in der Intensivmedizin“ (DAS-Leitlinie 2015)

Zusammenfassung

Intensivmedizinisch-behandelte Patienten werden mit den typischen Symptomen Angst, Stress, Schmerz, Schlaflosigkeit und Delir konfrontiert. Die aktuelle Version der S3-Leitlinie „Analgesie, Sedierung und Delirmanagement in der Intensivmedizin“ trägt auf der Basis des aktuellen Stands der Wissenschaft zu einem guten Behandlungserfolg bei. Die Leitliniengruppe mit Mandatsträgern aus 17 Fachgesellschaften hat daher folgenden Leitsatz gemeinsam konsentiert: Intensivmedizinisch-behandelte Patienten sollen wach, aufmerksam, schmerz-, angst- und delirfrei sein, um aktiv am Heilverlauf teilnehmen zu können.

Abstract

Critically ill patients suffer from anxiety, stress, pain, sleep disturbance and delirium. The updated version of the German evidence and consensus based guideline "Analgesia, Sedation and Delirium management in Intensive Care - DAS 2015" contributes an improved therapeutic management and is aimed to improve clinical outcome based on the current state of evidence. The task force members were representatives from 17 national medical societies therefore have consented following guiding principle in common: “Patients in intensive care shall be awake, alert and free of pain, anxiety and delirium, to be able to participate in the healing process actively.”

Kernaussagen

• Intensivpatienten sollen wach und partizipativ in ihren Behandlungsverlauf eingebunden sein.

• Es erfolgt keine Sedierung (Ziel-RASS 0/-1), außer sie ist indiziert.

• Wenn eine Sedierung indiziert ist, soll eine Übersedierung vermieden werden.

• Bei den präventiven Maßnahmen zur Vermeidung von Schmerzen, Angst, Stress, Schlafstörungen und Delir stehen nicht-pharmakologische Verfahren im Vordergrund.

• Zum Monitoring und zur zielgerichteten Behandlung von Analgesie, Sedierung, Delir und Angst stehen validierte Messinstrumente zur Verfügung.

• Analgesie, Sedierung, Angst und Delir sollen mind. einmal pro Schicht (in der Regel alle 8 h) dokumentiert werden.

• Schmerzen sollen adäquat therapiert sein. Opioidbasierte Verfahren stehen im Vordergrund.

• Angst, Stress, Delir, Schmerzen und Schlaflosigkeit sind symptomorientiert und protokollbasiert zu behandeln.

Schlüsselwörter:

Leitlinie - Intensivmedizin - Analgesie - Sedierung - Delir

Key words:

guideline - Intensive Care - analgesia - sedation - delirium

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