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ORIGINAL ARTICLE   Free accessfree

European Journal of Physical and Rehabilitation Medicine 2018 December;54(6):939-46

DOI: 10.23736/S1973-9087.18.05100-6


lingua: Inglese

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

Simone B. SCHMIDT 1 , Melanie BOLTZMANN 1, Markus Bertram 2, Christoph BUCKA 3, Michael HARTWICH 4, Michael JÖBGES 5, Guido KETTER 6, Bernd LEINEWEBER 7, Marion MERTL-RÖTZER 8, Dennis A. NOWAK 9, Thomas PLATZ 10, Klaus SCHEIDTMANN 11, Randall THOMAS 12, Friedrich von ROSEN 13, Claus W. WALLESCH 14, Hartwig WOLDAG 15, Peter PESCHEL 16, Jan MEHRHOLZ 17, Marcus POHL 18, Jens D. ROLLNIK 1

1 Institute for Neurorehabilitation Research (InFo), BDH-Klinik Hessisch Oldendorf, Hannover Medical School, Hannover, Germany; 2 Kliniken Schmieder Heidelberg, Heidelberg, Germany; 3 Neurologische Klinik Westend, Bad Wildungen, Germany; 4 Asklepios Schlossberg Klinik Bad König, Bad König, Germany; 5 Brandenburg Klinik Bernau, Bernau bei Berlin, Germany; 6 Neurological Rehabilitation Centre “Godeshöhe”, Bonn, Germany; 7 Neurologische Klinik GmbH, Bad Neustadt, Germany; 8 Schön Klinik, Bad Aibling, Germany; 9 Helios Klinik, Kipfenberg, Germany; 10 BDH-Klinik Greifswald, Greifswald, Germany; 11 Hegau-Jugendwerk Gailingen, Gailingen am Hochrhein, Germany; 12 Asklepios Kliniken Schildautal, Seesen, Germany; 13 Schön Klinik, Bad Staffelstein, Germany; 14 BDH-Klinik Elzach, Elzach, Germany; 15 Neurologisches Rehabilitationszentrum Leipzig, Leipzig, Germany; 16 Department of Public Health, University of Dresden, Dresden, Germany; 17 Klinik Bavaria Kreischa, Kreischa Germany; 18 Klinik Schloss Pulsnitz, Pulsnitz, Germany

BACKGROUND: Studies analyzing risk factors of weaning failure in neurological and neurosurgical early rehabilitation (NNER) patients are rare.
AIM: The aim of this study was to identify clinical factors influencing the weaning of NNER patients.
DESIGN: An observational, retrospective data analysis of a German multicenter study was performed.
SETTING: German neurological early rehabilitation centers.
POPULATION: Inpatient ventilated NNER patients (N.=192) were enrolled in the study.
METHODS: Demographical data, main diagnosis, medical devices, special medical care and assessment instruments of functional abilities, consciousness and independence in activities of daily living were accrued and compared between patients with and without successful weaning. The prognostic power of factors associated with weaning success/failure was analyzed using binary logistic regression.
RESULTS: In total, 75% of the patients were successfully weaned. Colonization with multi-drug resistant bacteria and the need for dialysis were independent predictors of weaning failure. Successfully weaned patients had a shorter length of stay, better functional outcome, and lower mortality than non-successfully weaned patients.
CONCLUSIONS: Successfully weaned patients differ from patients with weaning failure in several clinical variables. All these variables are associated with the morbidity of the patient, indicating that the weaning process is strongly influenced by disease burden.
CLINICAL REHABILITATION IMPACT: Functional abilities, level of consciousness, independence in activities of daily living, colonization with multi-drug resistant bacteria, need for dialysis and disease duration might help to predict the weaning process of NNER.

KEY WORDS: Ventilator weaning - Neurology - Rehabilitation

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