[Delirium in the intensive care unit].
In recent years delirium in the intensive care unit (ICU) has internationally become a matter of rising concern for intensive care physicians. Due to the design of highly sophisticated ventilators the practice of deep sedation is nowadays mostly obsolete. To assess a ventilated ICU patient for delirium easy to handle bedside tests have been developed which permit a psychiatric scoring. The significance of ICU delirium is equivalent to organ failure and has been proven to be an independent prognostic factor for mortality and length of ICU and hospital stay. The pathophysiology and risk factors of ICU delirium are still insufficiently understood in detail. A certain constellation of pre-existing patient-related conditions, the current diagnosis and surgical procedure and administered medication entail a higher risk for the occurrence of ICU delirium. A favored hypothesis is that an imbalance of the neurotransmitters acetylcholine and dopamine serotonin results in an unpredictable neurotransmission. Currently, the administration of neuroleptics, enforced physiotherapy, re-orientation measures and appropriate pain treatment are the basis of the therapeutic approach.
von Haken
R
R
Klinik für Anaesthesiologie, Ruprecht-Karls-Universität Heidelberg, Deutschland. Rebecca.vonhaken@med.uni-heidelberg.de
Gruss
M
M
Plaschke
K
K
Scholz
M
M
Engelhardt
R
R
Brobeil
A
A
Martin
E
E
Weigand
M A
MA
D000437:Alcoholism / Q000150:complications; D018680:Cholinergic Antagonists / Q000009:adverse effects; D003422:Critical Care; D003693:Delirium / Q000209:etiology* / Q000523:psychology / Q000628:therapy; D003937:Diagnosis, Differential; D006801:Humans; D007902:Length of Stay; D018377:Neurotransmitter Agents / Q000378:metabolism / Q000502:physiology; D011183:Postoperative Complications / Q000628:therapy*; D011379:Prognosis; D011605:Psychoses, Substance-Induced / Q000523:psychology / Q000628:therapy; D012307:Risk Factors
D018680:Cholinergic Antagonists; D018377:Neurotransmitter Agents