Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2023
Review[Non-pharmacological Management of Postoperative Delirium].
Postoperative delirium is common especially in the elderly and is associated with high rates of morbidity and mortality. Non-pharmacological multicomponent interventions are effective in reducing the incidence and to a degree the duration of postoperative delirium and are recommended in international guidelines on postoperative delirium as first line intervention for management of delirium. ⋯ Bundles comprise strategies for oxygenation, mobilization, hydration and nutrition, sensory and cognitive stimulation, reorientation, modifications of environmental factors such as design aspects and noise reduction, adequate analgesia, management of agitation and anxiety, protecting circadian rhythms for example by adequate light exposure during daytime, family involvement and timely reduction of unnecessary catheters and anticholinergic drugs. The article aims at providing an overview of non-pharmacological management of postoperative delirium in the hospital.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2023
[Quality Contract for the Prevention of Postoperative Delirium].
Delirium is one of the most common postoperative complications. Delayed initiation of treatment leads to an increased mortality rate within the first 90 days and to an increased need for post-hospital care. Similarly, neurocognitive disorders (NCDs) occur in a quarter of affected patients over the long-term. ⋯ The digitization of cross-departmental processes in particular is an elementary component in a modern transformation process. This creates new opportunities and processes that offer added value for patients and caregivers. Patients thus experience delirium management as a coherent interdisciplinary and multiprofessional concept that is implemented transparently, comprehensibly, and evidence-based.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2023
[Diagnostic Stewardship - The right test for the right patient with the right consequences].
In 2023, the Society for Healthcare Epidemiology of America (SHEA) Task Force issued a practice recommendation on the integration of diagnostic stewardship into antibiotic stewardship (ABS) programs, which focuses on optimizing sample collection, processing, and reporting to ensure a correct test result on the one hand, and on the justifying indication to perform diagnostics on the other. Unnecessary microbiological or serological tests produce results that can then lead to unnecessary further tests for clarification or unnecessary antibiotic administration. A classic example is "routine" urine cultures before non-urological, surgical interventions, which often lead to the treatment of asymptomatic bacteriuria. ⋯ A particular problem is the distinction between contamination, colonization and infection, especially when samples are taken from catheters or drains. These materials should always be evaluated with extreme caution and may only be accepted at all if the clinical question is clear and subject to this very reservation. This article summarizes the existing evidence on diagnostic stewardship interventions and recommendations on their implementation, extrapolating the international literature to the specifications of the German health care system.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2023
Review[Prevention of Post-operative Delirium].
Postoperative delirium (POD) is an adverse but often preventable complication of surgery and surgery-related anaesthesia, and increasingly prevalent. This article provides an overview on non-pharmacological preventive measures, divided into individualized and non-individualized measures. ⋯ Based on the results of preoperative screenings for risk factors such as frailty or cognitive impairment, individualized measures may encompass prehabilitation, treatment of specific risk factors, operation room companionship or cognitive, motor, and sensory stimulation as well as social support. This article additionally lists several examples of best practice approaches already implemented in German-speaking countries and websites for further readings.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2023
[Pharmacological Management of Postoperative Delirium].
Postoperative delirium (POD) is a complex disorder with significant implications for health and well-being. Over the last few years, there has been a significant increase in awareness of the pathophysiological processes, the different clinical forms and the prevention of POD. ⋯ For treatment, non-pharmacological measures remain in the foreground, pharmacological therapy is only used for severe symptoms, and should be symptom-oriented and low-dosed. There is no drug that is suitable for delirium treatment alone.