TY  - JOUR
A1  - Eichler, Sarah
A1  - Salzwedel, Annett
A1  - Harnath, Axel
A1  - Butter, Christian
A1  - Wegscheider, Karl
A1  - Chiorean, Mihai
A1  - Völler, Heinz
A1  - Reibis, Rona Katharina
T1  - Nutrition and mobility predict all-cause mortality in patients 12 months after transcatheter aortic valve implantation
JF  - Clinical research in cardiology : official journal of the German Cardiac Society.
N2  - The aim of the study was to determine pre-interventional predictors for all-cause mortality in patients after transcatheter aortic valve implantation (TAVI) with a 12-month follow-up. From 10/2013 to 07/2015, 344 patients (80.9 +/- 5.0 years, 44.5% male) with an elective TAVI were consecutively enrolled prospectively in a multicentre cohort study. Prior to the intervention, sociodemographic parameters, echocardiographic data and comorbidities were documented. All patients performed a 6-min walk test, Short Form 12 and a Frailty Index (score consisting of activities of daily living, cognition, nutrition and mobility). Peri-interventional complications were documented. Vital status was assessed over telephone 12 months after TAVI. Predictors for all-cause mortality were identified using a multivariate regression model. At discharge, 333 patients were alive (in-hospital mortality 3.2%; n = 11). During a follow-up of 381.0 +/- 41.9 days, 46 patients (13.8%) died. The non-survivors were older (82.3 +/- 5.0 vs. 80.6 +/- 5.1 years; p = 0.035), had a higher number of comorbidities (2.6 +/- 1.3 vs. 2.1 +/- 1.3; p = 0.026) and a lower left ventricular ejection fraction (51.0 +/- 13.6 vs. 54.6 +/- 10.6%; p = 0.048). Additionally, more suffered from diabetes mellitus (60.9 vs. 44.6%; p = 0.040). While the global Frailty Index had no predictive power, its individual components, particularly nutrition (OR 0.83 per 1 pt., CI 0.72-0.95; p = 0.006) and mobility (OR 5.12, CI 1.64-16.01; p = 0.005) had a prognostic impact. Likewise, diabetes mellitus (OR 2.18, CI 1.10-4.32; p = 0.026) and EuroSCORE (OR 1.21 per 5%, CI 1.07-1.36; p = 0.002) were associated with a higher risk of all-cause mortality. Besides EuroSCORE and diabetes mellitus, nutrition status and mobility of patients scheduled for TAVI offer prognostic information for 1-year all-cause mortality and should be advocated in the creation of contemporary TAVI risk scores.
KW  - TAVI
KW  - Frailty
KW  - Mortality
KW  - Malnutrition
KW  - Mobility
Y1  - 2018
U6  - https://doi.org/10.1007/s00392-017-1183-1
SN  - 1861-0684
SN  - 1861-0692
VL  - 107
IS  - 4
SP  - 304
EP  - 311
PB  - Springer
CY  - Heidelberg
ER  - 
TY  - JOUR
A1  - Heidler, Maria-Dorothea
A1  - Salzwedel, Annett
A1  - Jöbges, Michael
A1  - Lück, Olaf
A1  - Dohle, Christian
A1  - Seifert, Michael
A1  - von Helden, Andrea
A1  - Hollweg, Wibke
A1  - Völler, Heinz
T1  - Decannulation of tracheotomized patients after long-term mechanical ventilation - results of a prospective multicentric study in German neurological early rehabilitation hospitals
JF  - BMC Anesthesiology
N2  - Background: In the course of neurological early rehabilitation, decannulation is attempted in tracheotomized patients after weaning due to its considerable prognostic significance. We aimed to identify predictors of a successful tracheostomy decannulation. Methods: From 09/2014 to 03/2016, 831 tracheotomized and weaned patients (65.4 +/- 12.9 years, 68% male) were included consecutively in a prospective multicentric observation study. At admission, sociodemographic and clinical data (e.g. relevant neurological and internistic diseases, duration of mechanical ventilation, tracheotomy technique, and nutrition) as well as functional assessments (Coma Recovery Scale-Revised (CRS-R), Early Rehabilitation Barthel Index, Bogenhausener Dysphagia Score) were collected. Complications and the success of the decannulation procedure were documented at discharge. Results: Four hundred seventy patients (57%) were decannulated. The probability of decannulation was significantly negatively associated with increasing age (OR 0.68 per SD = 12.9 years, p < 0.001), prolonged duration of mechanical ventilation (OR 0.57 per 33.2 days, p < 0.001) and complications. An oral diet (OR 3.80; p < 0.001) and a higher alertness at admission (OR 3.07 per 7.18 CRS-R points; p < 0.001) were positively associated. Conclusions: This study identified practically measurable predictors of decannulation, which in the future can be used for a decannulation prognosis and supply optimization at admission in the neurological early rehabilitation clinic.
KW  - Mechanical ventilation
KW  - Tracheostomy
KW  - Decannulation
KW  - Prognosis
Y1  - 2018
U6  - https://doi.org/10.1186/s12871-018-0527-3
SN  - 1471-2253
VL  - 18
PB  - BMC
CY  - London
ER  -