title: [Delirium, analgesia, and sedation in intensive care medicine : Development of a protocol-based management approach].
abstract: Intensive care treatment has long-term consequences that are often not immediately apparent to the health care providers. The combination of muscle weakness, cognitive damage, and psychological disorders is comprised under the term post-intensive care syndrome (PICS). Analgesia and sedation protocols, as well as nonpharmacological preventive and therapeutic approaches, are effective tools for avoiding complications and improving long-term survival. The principle of "early goal-directed therapy" is fundamental. Here, a treatment target is defined and continuously re-evaluated by validated monitoring methods. Evidence clearly supports a paradigm shift towards patients that are awake, attentive, and able to participate in their therapy. Individualized analgesia and (non)sedation approaches allow a Richmond Agitation-Sedation Scale (RASS) target value of 0/-1 for the majority of patients. Should sedation indeed be necessary, there must be a focus on avoiding oversedation, especially an early deep sedation.
authors.affiliation: Universitätsklinik für Anästhesiologie m. S. operative Intensivmedizin, Campus Virchow-Klinikum und Campus Mitte, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Wolf
authors.affiliation: Universitätsklinik für Anästhesiologie m. S. operative Intensivmedizin, Campus Virchow-Klinikum und Campus Mitte, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
authors.forename: R
authors.initials: R
authors.lastname: Mörgeli
authors.affiliation: Universitätsklinik für Anästhesiologie m. S. operative Intensivmedizin, Campus Virchow-Klinikum und Campus Mitte, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Müller
authors.affiliation: Universitätsklinik für Anästhesiologie m. S. operative Intensivmedizin, Campus Virchow-Klinikum und Campus Mitte, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
authors.forename: B
authors.initials: B
authors.lastname: Weiss
authors.affiliation: Universitätsklinik für Anästhesiologie m. S. operative Intensivmedizin, Campus Virchow-Klinikum und Campus Mitte, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland. claudia.spies@charite.de.
authors.forename: C
authors.initials: C
authors.lastname: Spies
keywords: Cognitive function; Confusion; Guidelines; Psychomotor agitation; Therapy