Analgesie, Sedierung und Delirmanagement – Die DAS-Leitlinie 2015: Kinder und Neugeborene

Der pädiatrische Teil der S3-Leitlinie „Analgesie, Sedierung und Delirmanagement in der Intensivmedizin“ hat das Ziel, Kolleginnen und Kollegen, die in die Betreuung von Neugeborenen und Kindern auf Intensivstationen involviert sind, eine umfassende evidenz- und konsensus-basierte Handlungsgrundlage zu geben. Zugleich sollen Impulse für weitere Forschungsaktivitäten gegeben werden. In der Überarbeitung von 2015 werden klinisch relevanten Schlüsselfragen entsprechend der aktuellen Studienlage aus pflegerischer und ärztlicher Sicht neu beleuchtet.

The pediatric section of the S3 guideline „Analgesia, sedation and management of delir on intensive care units” aims to give evidence- and consensus-based monitoring and treatment recommendations for neonatal and pediatric intensive care teams. Simultaneously, it should provide an impulse for further research activities. The guideline's update of 2015 re-evaluates clinical key aspects on the basis of up to date evidence.

Kernaussagen

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

• Altersgemäße, validierte Scoringsysteme sollen bei Kindern zur Therapiesteuerung und Überwachung von Analgesie und Sedierung eingesetzt werden.

• Kinder sollen nach Möglichkeit ihre Schmerzen selbst einschätzen.

• Kritisch kranke Kinder sollen eine an die individuelle Situation angepasste Schmerztherapie erhalten, unabhängig von der Notwendigkeit einer Sedierung.

• Bei starken Schmerzen sollte die kontinuierliche i. v. Infusion eines Opiods bei Neugeborenen und Kindern angewendet werden. Bei älteren Kindern sollte eine Kombination mit einem Nicht-Opioid erfolgen.

• Lokale und regionale periphere und rückenmarksnahe Analgesieverfahren sollten bei der analgetischen Therapie berücksichtigt werden.

• Nicht pharmakologische Interventionen des Schmerzmanagements sowie eine allgemeine Reduktion äußerer Umgebungsstimuli (z. B. Licht, Geräusche) sind eine obligate Ergänzung pharmakologischer Maßnahmen.

• Bei Notwendigkeit einer Dauersedierung sollte eine sorgfältige Titration auf die niedrigstmögliche Dosis erfolgen. Eine dauerhafte Sedierung von Neugeborenen soll nur in absoluten Ausnahmefällen durchgeführt werden.

• Es soll ein regelmäßiges gezieltes Screening auf Entzugssymptome sowie delirante Symptome mit einem validierten, pädiatrischen Score erfolgen.

• Die Therapie des Delirs bei Kindern sollte symptomorientiert, pharmakologisch und nicht-pharmakologisch mit psychosozialen Interventionen erfolgen und eine Differenzialdiagnostik zu kausalen Ursachen beinhalten.

• Auf neonatologischen oder pädiatrischen Intensivstationen sollte ein normales Schlafmuster gefördert werden; insbesondere sollte auf eine adäquate Beleuchtung, Reduktion von Lärm und einen möglichst angepassten Tag-Nacht-Rhythmus der Patienten geachtet werden.

Schlüsselwörter:

Intensivmedizin - S3 Leitlinie - AWMF - Deutschland

Keywords:

intensive care medicine - S3 guideline - AMWF - Germany

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