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Journal Club AINS 2016; 5(04): 210-214
DOI: 10.1055/s-0041-110891
Leitlinien in der Praxis
© Georg Thieme Verlag Stuttgart · New York

Delirmanagement, Analgesie, Sedierung - Die neue S3-Leitlinie

Thomas Bein
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Publikationsverlauf

Publikationsdatum:
14. Dezember 2016 (online)

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Mit dem Update der S3-Leitlinie zur Sedierung, Analgesie und Delirmanagement vom Oktober 2015 wurde die 2. Version dieser bedeutenden Leitlinie veröffentlicht, die bis 2020 gültig ist [1]. Zählt man die 2005 erschienene S2-Leitlinie ebenfalls hinzu, betreibt man in Deutschland bereits seit über einem Jahrzehnt leitliniengestützte Analgesie und Sedierung auf der Intensivstation [2], [3].

Kernaussagen

  • Der intensivmedizinisch behandelte Patient soll wach, aufmerksam, schmerz-, angst- und delirfrei sein, um an seiner Behandlung und Genesung aktiv teilnehmen zu können.

  • Ziel und derzeitiger Grad von Delir, Sedierung, Analgesie und Angst sollten mindestens einmal pro Schicht erhoben und dokumentiert werden.

  • Sedierung ist einer der wesentlichen Risikofaktoren für die Entwicklung eines Delirs.

  • Ein nicht pharmakologischer Präventions- und Therapieansatz für ein Delir mit Frühmobilisierung, Reorientierung und kognitiver Stimulierung wird empfohlen.

  • Ein Delir sollte umgehend symptomatisch behandelt werden. Zur Therapie wird eine kontinuierliche Gabe von Alpha2-Agonisten empfohlen

  • Unruhige Patienten sollte man auf Schmerzen untersuchen. Noch vor einer Sedierung muss eine ausreichende Analgesie erreicht werden.

  • Angestrebt wird ein Sedierungsniveau mit einem RASS von 0 bis -1, eine tiefere Sedierung ist speziellen Indikationen vorbehalten (z. B. Schädel-Hirn-Trauma).

  • Ein täglicher Aufwachversuch wird nur bei Patienten mit einem RASS < -2 empfohlen, sofern keine Kontraindikationen bestehen.

 

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