Factors influencing weaning from mechanical ventilation in neurological and neurosurgical early rehabilitation patients

Schmidt, Simone; Boltzmann, Melanie; Bertram, Mathias; Bucka, C.; Hartwich, M.; Jöbges, Michael; Ketter, G.; Leineweber, Bernd; Mertl-Rötzer, M.; Nowak, Dennis A.; Platz, Thomas; Scheidtmann, Karl Heinz; Thomas, R.; Rosen, F. von; Wallesch, C. W.; Woldag, H.; Peschel, Peter; Mehrholz, Jan; Pohl, Marcus; Rollnik, Jens D.

doi:10.23736/s1973-9087.18.05100-6

Cited by 8 publications

(6 citation statements)

References 46 publications

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“…The current study used the Barthel Index and Early Rehabilitation Index upon admission as match criteria to homogenize the functional status of both groups at study entry. However, a recent study [20] investigating clinical factors influencing the weaning of phase B patients, showed that successfully and non-successfully weaned patients did not differ in Early Rehabilitation Index, but in other assessment scales (i.e. the Glasgow Coma Scale and Functional Ambulation Categories) upon admission.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, the present study showed an influence of PSH severity on weaning duration. However, several other factors such as the need of dialysis or colonization with multi-drug-resistant bacteria are associated with weaning failure during phase B treatment [20]. Additionally, the presence of PSH symptoms and PSH severity had no influence on length of stay at the ICU.…”

Section: Discussionmentioning

confidence: 99%

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Influence of paroxysmal sympathetic hyperactivity (PSH) on the functional outcome of neurological early rehabilitation patients: a case control study

et al. 2019

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Background Paroxysmal Sympathetic Hyperactivity (PSH) is a frequently observed condition among critically ill patients on intensive care units. According to different studies, PSH is associated with worse recovery and increased mortality in acute-care facilities. In this monocentric, retrospective case-control study, we investigated whether this association also applies to post-acute neurological early rehabilitation. Methods The study included n = 387 patients, admitted to an intensive care or intermediate care unit within 1 year (2016). Among these, 97 patients showed clinical signs of PSH. For each patient with PSH, a patient without PSH was identified, controlling for age, gender, functional and respiratory status upon admission. However, for 25 patients with PSH, there was no suitable control patient fulfilling all defined matching criteria. Primary outcome was type of discharge, dichotomized into favorable (follow-up rehabilitation) and unfavorable outcome (all others). Secondary outcome measures were functional and respiratory status, number of secondary diagnoses, duration of treatment interruptions and length of stay at discharge. Results About 25% of neurological early rehabilitation patients showed clinical signs of PSH. A young age (OR = 0.94; CI = 0.91–0.97) and less severe PSH symptoms (OR = 0.79; CI = 0.69–0.90) were independent predictors of a favorable outcome. In addition, severity of PSH symptoms was associated with weaning duration, while the occurrence of PSH symptoms alone had no influence on most secondary outcome variables. The treatment on intermediate care units proved to be longer for patients with PSH symptoms, only. Conclusions Patients with PSH represent a large group of neurological early rehabilitation patients. Overall, we did not find PSH-related differences in most of the examined outcome measures. However, severe PSH symptoms seem to be associated with poorer outcome and longer treatment on intermediate care units, in order to prevent possible complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Influence of paroxysmal sympathetic hyperactivity (PSH) on the functional outcome of neurological early rehabilitation patients: a case control study

et al. 2019

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“…This finding might be regarded as a devastating result, questioning the efficacy of post-acute rehabilitation. However, it has been shown in previous studies that neurological rehabilitation is effective in reducing the dependence on nursing care, quality of life [ 24 ] and the weaning of neurological patients from mechanical ventilation [ 25 , 26 ]. The present study used a relatively rough outcome assessment, which is not suitable to reveal subtle but relevant improvements.…”

Section: Discussionmentioning

confidence: 99%

One-year outcome of brain injured patients undergoing early neurological rehabilitation: a prospective observational study

et al. 2022

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Background The present study intended to analyze the outcome of patients with severe brain injury one-year after discharge from early rehabilitation. Methods Early neurological rehabilitation patients admitted to intensive or intermediate care units and discharged between June 2018 and May 2020 were screened for eligibility. The level of consciousness was evaluated using the Coma Recovery Scale-Revised (CRS-R) upon admission and at discharge. At one-year follow-up, the outcome was assessed with the Glasgow Outcome Scale-extended (GOSE). Demographical and clinical data collected during inpatient rehabilitation were used to predict the outcome 1 year after discharge. Results Two hundred sixty-four patients (174 males, 90 females) with a median age of 62 years (IQR = 51–75) and a median duration of their disease of 18 days (IQR = 12–28) were included in the study. At follow-up, the mortality rate was 27% (n = 71). Age and discharge CRS-R total score were independent predictors in a Cox proportional hazards model with death (yes/no) as the dependent variable. According to the GOSE interviews, most patients were either dead (n = 71; 27%), in a vegetative state (n = 28; 11%) or had a severe disability (n = 124; 47%), whereas only a few patients showed a moderate disability (n = 18; 7%) or a good recovery (n = 23; 9%) 1 year after discharge. Age, non-traumatic etiology, discharge CRS-R total score and length of stay independently predicted whether the outcome was good or poor at follow-up. Conclusion Age was an important predictor for outcome at one-year follow-up, which might be due to altered brain plasticity and more comorbidities in elderly subjects. In addition, the present study demonstrated that the CRS-R total score at discharge might be more important for the prediction of one-year outcome than the initial assessment upon admission.

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“…Bei nicht rechtzeitiger Erkennung durch ein risikobasiertes Screening können diese weiterverbreitet werden. Mit der Besiedlung durch MRE steigt die Wahrscheinlichkeit für ein ungünstiges Rehabilitationsoutcome 11 12 13 .…”

Section: Ursachen Der Erhöhten Infektionsgefährdung In Der ...unclassified

Nosokomiale Infektionsgefährdung und Prävention in der neurologisch-neurochirurgischen Frührehabilitation

Krämer¹,

Platz²

2022

neuroreha

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Deutschlands Rehabilitationseinrichtungen bilden die zweite große Säule der stationären Patientenversorgung. Die für den Rehabilitationserfolg entscheidenden multimodalen Therapien weisen regelhaft einen engen Kontakt der Behandelnden zu Patient*innen auf, was mit vielfältigen Übertragungsmöglichkeiten für Infektionen verbunden ist. Aus diesem Grund sollte zur Infektionsprävention in der neurologisch-neurochirurgischen Frührehabilitation (NNFR) – insbesondere wegen der im Vergleich zu anderen Rehabilitationsformen höheren Infektionsrisiken – ein der Patientenklientel angepasstes Präventionskonzept aufgestellt werden.

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Factors influencing weaning from mechanical ventilation in neurological and neurosurgical early rehabilitation patients

Cited by 8 publications

References 46 publications

Influence of paroxysmal sympathetic hyperactivity (PSH) on the functional outcome of neurological early rehabilitation patients: a case control study

Influence of paroxysmal sympathetic hyperactivity (PSH) on the functional outcome of neurological early rehabilitation patients: a case control study

One-year outcome of brain injured patients undergoing early neurological rehabilitation: a prospective observational study

Nosokomiale Infektionsgefährdung und Prävention in der neurologisch-neurochirurgischen Frührehabilitation

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