Langzeitfolgen nach Intensivtherapie

Viele Intensivpatienten sind nach der Klinik-Entlassung von schwerwiegenden persistierenden oder neu aufgetretenen körperlichen, kognitiven, psychischen und sozialen Folgen betroffen (Post-ICU-Syndrom). Dies hat sowohl Auswirkung auf das weitere Leben als auch auf die Prognose. Maßnahmen zur Verminderung bzw. Vermeidung dieser Komplikationen und eine strukturierte Behandlung nach Entlassung müssen wesentliche Ziele der Intensivmedizin darstellen.

Abstract

Many intensive care patients are affected by serious persistent or new physical, cognitive, psychological, and social consequences after discharge (post-ICU syndrome). This has an impact on the rest of life as well as the prognosis. To reduce or avoid these complications and structured treatment after discharge must be essential goals of intensive care medicine. Prevention of PICS is of central importance. The knowledge that many elements of the symptoms are triggered or intensified by therapeutic treatments as part of intensive therapy offers the opportunity to modify. Therapy must be designed to reduce potential sequelae, with the avoidance of overtreatment, such as sedation. These understanding must lead to critically questioning who is admitted to an intensive care unit and for whom a realistic therapy goal in terms of functionality, quality of life and life expectancy can be achieved. Ultimately, the treatment of intensive care patients must not end when they are discharged from the intensive care unit or hospital. Patients at risk for the very different facets of a PICS must be identified and linked to appropriate care institutions. This requires the establishment of post-ICU facilities, such as consultation hours in clinics or outpatient clinics.

Kernaussagen

• Ein hoher Prozentsatz von Intensivpatienten hat nach der Entlassung massive körperliche, kognitive, intellektuelle und psychosoziale Beeinträchtigungen, die unter dem Terminus „Post-ICU-Syndrom“ zusammengefasst werden.

• Nach einem Intensivaufenthalt bestehen nicht nur weiter persistierende Schädigungen, sondern es treten vermehrt auch neue Krankheitszustände, wie kardiovaskuläre Ereignisse oder Organschäden, auf.

• Das PICS hat massive Auswirkungen auf den weiteren Lebenslauf, die Lebensqualität und Prognose von ehemaligen Intensivpatienten.

• Verschiedene Aspekte des PICS werden durch intensivmedizinische Maßnahmen (Über- bzw. Untertherapie) (mit)verursacht und können damit auch gemildert, selten ganz verhindert werden.

• Für die Aufnahme auf Intensivstationen und die Intensivbehandlung muss immer geklärt sein, bei welchem Patienten ein realistisches Therapieziel bezüglich Funktionalität, Lebensqualität und Lebenserwartung erreicht werden kann.

• Die Behandlung eines Intensivpatienten darf mit der Entlassung nicht zu Ende sein. Bei der Entlassung müssen (Risiko-)Patienten identifiziert und einer systematischen Betreuung zugeführt werden (Post-ICU-Care).

Schlüsselwörter

Intensivtherapie - Langzeitfolgen - Beatmung - Post-ICU-Syndrom - Post-ICU-Care

Keywords

intensive therapy - long-term consequences - post-ICU syndrome - ventilation - post-ICU care

Publication History

Article published online:
13 February 2024

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