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Warnke C, Heine A, Müller-Heinrich A, Knaak C, Friesecke S, Obst A, Bollmann T, Desole S, Boesche M, Stubbe B, Ewert R. Predictors of survival after prolonged weaning from mechanical ventilation. J Crit Care 2020; 60:212-217. [PMID: 32871419 DOI: 10.1016/j.jcrc.2020.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Weaning from mechanical ventilation is a key component of intensive care treatment; however, this process may be prolonged as some patients require care at specialised centres. Current data indicate that weaning from invasive mechanical ventilation is successful in approximately 65% of patients; however, data on long-term survival after discharge from a weaning centre are limited. MATERIALS AND METHODS We analysed predictors of survival among 597 patients (392 men, mean age 68 ± 11) post-discharge from a specialised German weaning centre. RESULTS Complete weaning from mechanical ventilation was achieved in 407 (57.8%) patients, and 106 patients (15.1%) were discharged with non-invasive ventilation; thus, prolonged weaning was successful in 72.9% of the patients. The one-year and five-year survival rates post-discharge were 66.5% and 37.1%, respectively. Age, duration of mechanical ventilation, certain clusters of comorbidities, and discharged with mechanical ventilation significantly influenced survival (p < .001). Completely weaned patients who were discharged with a tracheostomy had a significantly reduced survival rate than did those who were completely weaned and discharged with a closed tracheostomy (p = .004). CONCLUSIONS The identified predictors of survival after prolonged weaning could support therapeutic strategies during patients' intensive care unit stay. Patients should be closely monitored after discharge from a weaning centre.
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Affiliation(s)
- Christian Warnke
- University Hospital Greifswald, Department of Internal Medicine B, Cardiology, Pneumology, Infectious Diseases, Intensive Care Medicine, F.-Sauerbruchstr, D-17475 Greifswald, Germany
| | - Alexander Heine
- University Hospital Greifswald, Department of Internal Medicine B, Cardiology, Pneumology, Infectious Diseases, Intensive Care Medicine, F.-Sauerbruchstr, D-17475 Greifswald, Germany
| | - Annegret Müller-Heinrich
- University Hospital Greifswald, Department of Internal Medicine B, Cardiology, Pneumology, Infectious Diseases, Intensive Care Medicine, F.-Sauerbruchstr, D-17475 Greifswald, Germany
| | - Christine Knaak
- University Hospital Greifswald, Department of Internal Medicine B, Cardiology, Pneumology, Infectious Diseases, Intensive Care Medicine, F.-Sauerbruchstr, D-17475 Greifswald, Germany
| | - Sigrun Friesecke
- University Hospital Greifswald, Department of Internal Medicine B, Cardiology, Pneumology, Infectious Diseases, Intensive Care Medicine, F.-Sauerbruchstr, D-17475 Greifswald, Germany
| | - Anne Obst
- University Hospital Greifswald, Department of Internal Medicine B, Cardiology, Pneumology, Infectious Diseases, Intensive Care Medicine, F.-Sauerbruchstr, D-17475 Greifswald, Germany
| | - Tom Bollmann
- University Hospital Greifswald, Department of Internal Medicine B, Cardiology, Pneumology, Infectious Diseases, Intensive Care Medicine, F.-Sauerbruchstr, D-17475 Greifswald, Germany
| | - Susanna Desole
- University Hospital Greifswald, Department of Internal Medicine B, Cardiology, Pneumology, Infectious Diseases, Intensive Care Medicine, F.-Sauerbruchstr, D-17475 Greifswald, Germany
| | - Michael Boesche
- University Hospital Greifswald, Department of Internal Medicine B, Cardiology, Pneumology, Infectious Diseases, Intensive Care Medicine, F.-Sauerbruchstr, D-17475 Greifswald, Germany
| | - Beate Stubbe
- University Hospital Greifswald, Department of Internal Medicine B, Cardiology, Pneumology, Infectious Diseases, Intensive Care Medicine, F.-Sauerbruchstr, D-17475 Greifswald, Germany.
| | - Ralf Ewert
- University Hospital Greifswald, Department of Internal Medicine B, Cardiology, Pneumology, Infectious Diseases, Intensive Care Medicine, F.-Sauerbruchstr, D-17475 Greifswald, Germany
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Schmidt SB, Boltzmann M, Bertram M, Bucka C, Hartwich M, Jöbges M, Ketter G, Leineweber B, Mertl-Rötzer M, Nowak DA, Platz T, Scheidtmann K, Thomas R, Rosen FV, Wallesch CW, Woldag H, Peschel P, Mehrholz J, Pohl M, Rollnik JD. Factors influencing weaning from mechanical ventilation in neurological and neurosurgical early rehabilitation patients. Eur J Phys Rehabil Med 2019. [DOI: 10.23736/s1973-9087.18.05100-6 epub 2018 jun 11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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[Weaning from dialysis after acute kidney injury in chronically critically ill]. Med Klin Intensivmed Notfmed 2018; 114:459-462. [PMID: 30302526 DOI: 10.1007/s00063-018-0488-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 07/31/2018] [Accepted: 08/30/2018] [Indexed: 10/28/2022]
Abstract
This study describes the course of renal recovery after dialysis in a specific population of chronically critically ill patients with a history of prolonged and complicated treatment in an intensive care unit. This study shows that, in a specialized center, patients can be successfully weaned from dialysis even months after acute kidney injury (AKI). Of the patients who could be recompensated (33%), approximately 20% achieved renal recovery more than 3 months after the start of dialysis. The duration of renal recovery after AKI did not differ between those patients with pre-existing chronic kidney disease (CKD) and those without. The reason for dialysis treatment such as sepsis, surgery, resuscitation, as well as the risk factors (e. g., diabetes mellitus, arterial hypertension, arteriosclerosis) did not reveal a difference in weaning in a hazard analysis. As a potential risk factor, only age significantly influenced weaning from dialysis in the multivariate hazard model.
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Schmidt SB, Boltzmann M, Bertram M, Bucka C, Hartwich M, Jöbges M, Ketter G, Leineweber B, Mertl-Rötzer M, Nowak DA, Platz T, Scheidtmann K, Thomas R, Rosen FV, Wallesch CW, Woldag H, Peschel P, Mehrholz J, Pohl M, Rollnik JD. Factors influencing weaning from mechanical ventilation in neurological and neurosurgical early rehabilitation patients. Eur J Phys Rehabil Med 2018; 54:939-946. [PMID: 29898584 DOI: 10.23736/s1973-9087.18.05100-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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.
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Affiliation(s)
- Simone B Schmidt
- Institute for Neurorehabilitation Research (InFo), BDH-Klinik Hessisch Oldendorf, Hannover Medical School, Hannover, Germany -
| | - Melanie Boltzmann
- Institute for Neurorehabilitation Research (InFo), BDH-Klinik Hessisch Oldendorf, Hannover Medical School, Hannover, Germany
| | | | | | | | | | - Guido Ketter
- Neurological Rehabilitation Centre "Godeshöhe", Bonn, Germany
| | | | | | | | | | | | | | | | | | - Hartwig Woldag
- Neurologisches Rehabilitationszentrum Leipzig, Leipzig, Germany
| | - Peter Peschel
- Department of Public Health, University of Dresden, Dresden, Germany
| | | | | | - Jens D Rollnik
- Institute for Neurorehabilitation Research (InFo), BDH-Klinik Hessisch Oldendorf, Hannover Medical School, Hannover, Germany
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Trapp O, Fiedler M, Hartwich M, Schorl M, Kalenka A. Monitoring of Electrical Activity of the Diaphragm Shows Failure of T-Piece Trial Earlier than Protocol-Based Parameters in Prolonged Weaning in Non-communicative Neurological Patients. Neurocrit Care 2018; 27:35-43. [PMID: 28063121 DOI: 10.1007/s12028-016-0360-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The weaning target in tracheotomised patients is not extubation, but spontaneous breathing without the support of a ventilator. Overloading the respiratory pump during such spontaneous breathing trials is unfavorable, prolongs weaning time, and increases morbidity and mortality. The goal of this study was to evaluate the electrical activity of the diaphragm during a t-piece trial in non-communicative neurological patients and the comparison to clinical parameters of exhaustion. METHODS During multiple t-piece trials, the electrical activity of the diaphragm was obtained before, during and after the end of the trial. T-piece trials were grouped based on the reason for stopping the trial (exhaustion or allotted time period). RESULTS Twenty-nine tracheotomised patients in prolonged weaning (29 ± 22 days ventilated at the start of the study) were included in a prospective observational study. T-piece trials (n = 152; 5 ± 2 per patient) were grouped based on the reason for stopping the trial (n = 91 because of exhaustion; n = 61 because of the allotted time period). We found that the electrical activity of the diaphragm exhibits an earlier increase than protocol-based clinical parameters in patients who failed the trial due to exhaustion. The electrical activity of the diaphragm shows no relevant difference during the t-piece trial in patients in whom the trial was stopped due to the allotted time period per protocol. CONCLUSIONS Monitoring the electrical activity of the diaphragm in non-communicative neurological patients in prolonged weaning allows earlier detection of exhaustion than protocol-based parameters.
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Affiliation(s)
- Oliver Trapp
- Asklepios Schlossberg Clinic, Bad König, Germany
| | - Mascha Fiedler
- Clinic for Anaesthesiology and Operative Intensive Care Medicine, University Medical Centre Mannheim, Mannheim, Germany
| | | | - Martin Schorl
- Passauer Wolf Rehabilitation Center, Neurology, Bad Gögging, Germany
| | - Armin Kalenka
- Department of Anaesthesiology and Intensive Care Medicine, Hospital Bergstrasse, Heppenheim, Germany. .,Medical Faculty Heidelberg, Heidelberg, Germany.
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[Prolonged weaning during early neurological and neurosurgical rehabilitation : S2k guideline published by the Weaning Committee of the German Neurorehabilitation Society (DGNR)]. DER NERVENARZT 2018; 88:652-674. [PMID: 28484823 DOI: 10.1007/s00115-017-0332-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Prolonged weaning of patients with neurological or neurosurgery disorders is associated with specific characteristics, which are taken into account by the German Society for Neurorehabilitation (DGNR) in its own guideline. The current S2k guideline of the German Society for Pneumology and Respiratory Medicine is referred to explicitly with regard to definitions (e.g., weaning and weaning failure), weaning categories, pathophysiology of weaning failure, and general weaning strategies. In early neurological and neurosurgery rehabilitation, patients with central of respiratory regulation disturbances (e.g., cerebral stem lesions), swallowing disturbances (neurogenic dysphagia), neuromuscular problems (e.g., critical illness polyneuropathy, Guillain-Barre syndrome, paraplegia, Myasthenia gravis) and/or cognitive disturbances (e.g., disturbed consciousness and vigilance disorders, severe communication disorders), whose care during the weaning of ventilation requires, in addition to intensive medical competence, neurological or neurosurgical and neurorehabilitation expertise. In Germany, this competence is present in centers of early neurological and neurosurgery rehabilitation, as a hospital treatment. The guideline is based on a systematic search of guideline databases and MEDLINE. Consensus was established by means of a nominal group process and Delphi procedure moderated by the Association of the Scientific Medical Societies in Germany (AWMF). In the present guideline of the DGNR, the special structural and substantive characteristics of early neurological and neurosurgery rehabilitation and existing studies on weaning in early rehabilitation facilities are examined.Addressees of the guideline are neurologists, neurosurgeons, anesthesiologists, palliative physicians, speech therapists, intensive care staff, ergotherapists, physiotherapists, and neuropsychologists. In addition, this guideline is intended to provide information to specialists for physical medicine and rehabilitation (PMR), pneumologists, internists, respiratory therapists, the German Medical Service of Health Insurance Funds (MDK) and the German Association of Health Insurance Funds (MDS). The main goal of this guideline is to convey the current knowledge on the subject of "Prolonged weaning in early neurological and neurosurgery rehabilitation".
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Hartwich M. [Weaning concepts in the setting of neurological disorders]. DER NERVENARZT 2017; 88:1195-1196. [PMID: 28929320 DOI: 10.1007/s00115-017-0419-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- M Hartwich
- Asklepios Schlossberg-Klinik Bad König, Frankfurter Str. 33, 64732, Bad König, Deutschland.
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Rehabilitationsverlauf von Patienten in der neurologisch-neurochirurgischen Frührehabilitation. DER NERVENARZT 2016; 87:634-44. [DOI: 10.1007/s00115-016-0093-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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9
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Infektionsschutz und spezielle Hygienemaßnahmen in klinischen Disziplinen. KRANKENHAUS- UND PRAXISHYGIENE 2016. [PMCID: PMC7152143 DOI: 10.1016/b978-3-437-22312-9.00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Ragaller M. [Augmented spontaneous breathing in the weaning process: technical gimmick or enrichment of intensive care medicine?]. Anaesthesist 2014; 63:276-8. [PMID: 24569932 DOI: 10.1007/s00101-014-2290-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- M Ragaller
- Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus, Medizinische Fakultät, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland,
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