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Intensivmedizin up2date 2019; 15(01): 91-110
DOI: 10.1055/s-0043-121669
Pädiatrische Intensivmedizin
Georg Thieme Verlag KG Stuttgart · New York

Pädiatrische Intensiv- und Palliativmedizin – unsere Patienten brauchen beides!

Ingeborg van den Heuvel
,
Silke Nolte-Buchholtz
,
Georg Rellensmann
Further Information

Publication History

Publication Date:
21 February 2019 (online)

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Noch vor wenigen Jahren wurden Intensiv- und Palliativmedizin von vielen als unvereinbare Disziplinen mit entgegengesetzten Zielen betrachtet. Heute setzt sich die Überzeugung durch, dass schwerkranke Intensivpatienten beides brauchen: aggressive Intensivtherapie und die Expertise der Palliativmedizin.
Kernaussagen

  • Intensivmedizin strebt primär nach Heilung und Gesundheit, während Palliativmedizin das Wohlbefinden des Kindes und seiner Familie im Fokus hat. Intensiv- und palliativmedizinische Ziele ergänzen sich.

  • Die Integration von Intensiv- und Palliativmedizin kann in einem Mixed-Modell erfolgen – dies erfordert palliativmedizinische Expertise im Intensivteam. Für spezielle Fragestellungen wird ein Palliativteam hinzugezogen.

  • Die Integration von Palliativmedizin in die Intensivmedizin kann dazu beitragen, nicht weniger Medizin, sondern eine gezieltere, bessere medizinische Versorgung in Übereinstimmung mit den Zielen und Prioritäten der Familie zu erreichen.

  • Leidvolle Symptome bei Patient und Familie sollen erkannt und ganzheitlich behandelt werden. Eine familienzentrierte Versorgung soll Standard in der pädiatrischen Intensivmedizin sein.

  • Ethische Konflikte über Therapieentscheidungen können anspruchsvoll sein. Mit einer strukturierten Herangehensweise und externer Moderation kann meist ein tragfähiger Konsens erreicht werden.

  • „Empfehlungen zum Vorgehen in Notfallsituationen“ (EVN) können bei der Festlegung und Kommunikation von Therapiezielen helfen. Sie sind rechtlich nicht verbindlich und bedeuten nicht, dass die übrige medizinische Therapie eingeschränkt werden soll.

  • Für eine Entlassung von der Intensivstation nach Hause oder in ein Hospiz ist eine vorausschauende Planung des medizinischen, psychosozialen und spirituellen Rahmens wichtig. Ein Behandlungsplan muss pragmatisch sicher umsetzbar sein und für Notfallsituationen vorsorgen.

Schlüsselwörter

pädiatrische Intensivmedizin - Palliativmedizin - Integration
 

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