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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE

A Journal on Physical Medicine and Rehabilitation after Pathological Events


Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
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European Journal of Physical and Rehabilitation Medicine 2017 June;53(3):441-6

DOI: 10.23736/S1973-9087.17.04300-3

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Weaning of neurological early rehabilitation patients from mechanical ventilation: a retrospective observational study

Jens D. ROLLNIK 1 , Joachim K. KRAUSS 2, Christoph GUTENBRUNNER 3, Claus WALLESCH 4, Thomas MÜNTE 5, Martin STANGEL 6

1 Institute for Neurorehabilitation Research (InFo), BDH Clinic Hessisch Oldendorf, Hannover Medical School, Hessisch Oldendorf, Germany; 2 Department of Neurosurgery, Hannover Medical School, Hannover, Germany; 3 Department of Physical Medicine and Rehabilitation, Hannover Medical School, Hannover, Germany; 4 BDH Clinic Elzach, Elzach, Germany; 5 Department of Neurology, University of Lübeck, Lübeck, Germany; 6 Department of Neurology, Hannover Medical School, Hannover, Germany


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BACKGROUND: There is little known about the factors influencing the weaning process of long-term mechanically ventilated patients in the neurological early rehabilitation.
AIM: The aim of this study was to identify salient clinical and neurophysiological variables with impact upon weaning from mechanical ventilation during neurological and neurosurgical early rehabilitation.
DESIGN: Observational, retrospective data analysis.
SETTING: The BDH-Clinic Hessisch Oldendorf in Northern Germany.
POPULATION: A sample of 65 mechanically ventilated neurological and neurosurgical early rehabilitation patients. Most patients were suffering from brain disorders (stroke, brain hemorrhage, hypoxic brain damage).
METHODS: Clinical (ventilation hours, duration of daily therapy, Barthel Index [BI]) and neurophysiological data (evoked potentials) were analyzed retrospectively. The data was collected from the medical records of patients treated in our weaning facility.
RESULTS: Weaning was successful in 92.3% (60/65) of all cases after a mean of 341.1 (±423.9) hours of ventilation; 2 patients (3.1%) died during the course of weaning and 3 (4.6%) were discharged on home ventilation. There was no significant correlation between ventilation hours and the amount of daily physio-, occupational or speech therapy, but there was a tendency towards a negative correlation of cognitive therapy with ventilation hours (rs=-0.234, P=0.088). Longer periods of ventilation correlated with poorer outcomes as measured by improvements in the BI (rs=-0.259, P<0.05). The more secondary diagnoses - a surrogate indicator of the total burden of morbidity - the more ventilation hours were necessary to wean the patient (rs=0.268, P<0.05). Patients isolated due to colonization with multi-drug resistant bacteria tended to require longer periods of ventilation than non-isolated persons (413.2 [±463.7] vs. 158.8 [±221.6], P=0.068). Data of evoked potentials did not correlate with ventilation hours.
CONCLUSIONS: Most patients could be weaned from mechanical ventilation during early rehabilitation within approximately two weeks. Results from this study suggest that patients’ morbidity (as indicated by the total number of secondary diagnoses) and isolation due to colonization with multi-drug resistant bacteria may be deleterious to the weaning process.
CLINICAL REHABILITATION IMPACT: In evaluation of the weaning prognosis of critically ill neurological and neurosurgical early rehabilitation patients, concomitant morbidity and colonization with multi-drug resistant bacteria should be taken into account.


KEY WORDS: Respiration, artificial - Critical care - Ventilator weaning - Rehabilitation

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Publication History

Issue published online: June 15, 2017
Article first published online: April 4, 2017
Manuscript accepted: March 22, 2017
Manuscript revised: March 13, 2017
Manuscript received: April 7, 2016

Cite this article as

Rollnik JD, Krauss JK, Gutenbrunner C, Wallesch C, Münte T, Stangel M. Weaning of neurological early rehabilitation patients from mechanical ventilation: a retrospective observational study. Eur J Phys Rehabil Med 2017;53:441-6. DOI: 10.23736/S1973-9087.17.04300-3

Corresponding author e-mail

prof.rollnik@bdh-klinik-hessisch-oldendorf.de