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Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52(02): 137-144
DOI: 10.1055/s-0042-103263
Fachwissen
Georg Thieme Verlag KG Stuttgart · New York

Folgen kritischer Erkrankung und mögliche Interventionen

Frank Dodoo-Schittko
,
Susanne Brandstetter
,
Christian Apfelbacher
,
Thomas Bein
Further Information

Publication History

Publication Date:
21 February 2017 (online)

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Zusammenfassung

Nach überlebter kritischer Erkrankung leiden Patienten häufig unter einer persistierenden körperlichen und mentalen Morbidität, die nicht allein auf die Grunderkrankungen zurückzuführen ist. Eine häufig zu findende Kombination aus physischen, psychischen und kognitiven Defiziten wird als Post-intensive Care Syndrome (PICS) bezeichnet. Der nachfolgende Artikel beleuchtet die Epidemiologie dieser Beeinträchtigungen und stellt post-intensivmedizinische Interventionen mit dem Ziel der Prävention und Therapie vor.

Wenn Patienten eine kritische Erkrankung überlebt haben, leiden sie oft unter einer persistierenden körperlichen und mentalen Morbidität. Eine häufig auftretende Kombination aus physischen, psychischen und kognitiven Defiziten wird als Post-intensive Care Syndrome (PICS) bezeichnet. Dieser Artikel beleuchtet die Epidemiologie dieser Beeinträchtigungen und stellt post-intensivmedizinische Interventionen mit dem Ziel der Prävention und Therapie vor.

Abstract

Surviving critical illness is often associated with persistent physical and mental morbidity, which cannot be reduced to late sequelae of the primary underlying diseases. A frequent combination of physical, mental and cognitive deficits is referred to as post-intensive care syndrome (PICS). This article illuminates the epidemiology of these impairments and discusses post-intensive care interventions aiming at prevention and recovery.

Kernaussagen

  • Nach überlebter kritischer Erkrankung tritt eine Vielzahl körperlicher, psychischer und kognitiver Defizite auf, die zusammengefasst Post-intensive Care Syndrome (PICS) genannt werden. Komponenten sind z. B.: Intensive Care Unit-acquired Weakness (ICUAW), chronischer Schmerz, Schluckstörungen, sexuelle Dysfunktion, Depression, posttraumatische Belastungsstörung, Angststörungen und kognitive Defizite.

  • Auch Angehörige zeigen noch lange nach der Entlassung der Intensivpatienten erhöhte Inzidenzraten für bestimmte psychiatrische Erkrankungen.

  • Spezielle Nachsorgekonzepte sollen die Prävention, Früherkennung und Behandlung von typischen Folgeerkrankungen einer Intensivbehandlung sicherstellen.

  • In Großbritannien sind Intensiv-Nachsorge-Kliniken, die an die Intensivstationen angebunden sind, weit verbreitet. Die Evidenz der Wirksamkeit dieser von Intensivmedizinern, Pflegewissenschaftlern oder auch Sozialarbeitern geleiteten Einrichtungen ist derzeit aber noch gering.

  • In Deutschland zeigte eine komplexe Intervention für Sepsispatienten mit dem Fokus auf den nachbehandelnden Hausärzten keine signifikanten Effekte auf die gesundheitsbezogene Lebensqualität.

  • Die Aufzeichnung von Intensiv-Tagebüchern durch Pflegekräfte soll vor allem psychiatrische Symptome verringern. Die Tagebücher sollen dem Patienten nach der Entlassung helfen, bestehende Gedächtnislücken für die Zeit auf der Intensivstation zu füllen und beängstigende, halluzinatorische Pseudoerinnerungen zu korrigieren.

  • Physische Rehabilitationsprogramme sind eine vielversprechende Intervention bei der häufigen neuromuskulären Beeinträchtigung nach prolongierter Intensivbehandlung (ICUAW).

  • Da Überlebende einer kritischen Erkrankung oft an einer Depression leiden, ist besonders auf die Motivation für und die Adhärenz zu Rehabilitationsprogrammen zu achten. Kognitiv-verhaltenstherapeutische Ansätze sind hier erfolgversprechend.

Schlüsselwörter

kritische Erkrankung - Intensivmedizin - Post-intensive Care Syndrome - post-intensivmedizinische Interventionen

Key words

critical illness - intensive care - post-intensive care syndrome - post-intensive care interventions
 

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