Wie können postoperativ ein Delir und eine neurokognitive Störung verhindert werden?

Zusammenfassung

Ein postoperatives Delir (POD) geht mit einem hohen Leidensdruck für die betroffenen Patienten und ihre Angehörigen und einem großen Mehraufwand für das klinische Personal einher. Darüber hinaus belasten die entstehenden Kosten erheblich das Gesundheitssystem. Der Beitrag beleuchtet die Optionen der Risikoreduktion in der postoperativen Versorgung, um ein POD und eine postoperative neurokognitive Störung zu vermeiden.

Abstract

Postoperative delirium (POD) is a common and serious complication after surgery. It is associated with increased morbidity and mortality as well as neurocognitive disorder and associated loss of autonomy and increased need for care. As professionals, it is our duty to treat our patients in a holistic individual concept with the aim to reintegrate our patients into their home and social environment afterwards. In addition to preoperative and intraoperative interventions, postoperative prevention is of particular importance. This article focuses on non-pharmacological prevention strategies to avoid postoperative delirium and neurocognitive disorder in postoperative inpatient care. It is based on the “Evidence-based and consensus-based guideline on postoperative delirium”. Thus, risk factors are addressed and non-pharmacological strategies are presented, which include reorientation, mobilization and nutritional support. Interprofessional cooperation plays just as important a role as the implementation of the listed preventive measures. Finally, the modified Hospital Elder Life Program is presented, which presents and applies preventive measures as a system-oriented and interdisciplinary concept, which “prevents functional decline and allows older adults to return home at the maximal level of independence”. From our point of view, the training of a professional delirium team is a future-oriented complementary measure in the treatment concept of Perioperative Neurocognitive Disorders (PND), which finds its justification as an interface in the treatment of high-risk patients.

Kernaussagen

• Die effektive Prävention von perioperativen neurokognitiven Störungen erfordert ein Bündel von Maßnahmen, die strukturiert umgesetzt werden müssen:

• sorgfältige Identifikation von Risikofaktoren (GoR A) gemäß Leitlinie der European Society of Anaesthesiology,

• Implementierung eines validierten Scores für Delir-Screenings: tägliche Anwendung mind. 1-mal pro Schicht bis zum 5. postoperativen Tag einschließlich,

• Anwendung evidenzbasierter Präventionsmaßnahmen: Hilfsmittel zur Orientierung und zur Kommunikation, Unterstützung des Tag-Nacht-Rhythmus, frühzeitige Mobilisierung unterstützen, frühe enterale Belastung unterstützen (wenn keine Kontraindikation besteht), adäquate Schmerztherapie,

• interprofessionelle Zusammenarbeit unterstützen und stärken,

• Vorhalten eines professionellen Delirteams,

• Integrierung von Angehörigen und ehrenamtlichen Helfern, z. B. gemäß dem HELP-Konzept,

• bei diagnostiziertem POD (auch bereits bei subsyndromalem Delir) umgehende Ursachenabklärung und Behandlung.

Schlüsselwörter

postoperatives Delir - Delir-Screening - HELP - Delirteam - Prävention

Key words

postoperative delirium - delirium screening - HELP - delirium team - prevention

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