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  - 
TY  - JOUR
A1  - Salzwedel, Annett
A1  - Reibis, Rona Katharina
A1  - Wegscheider, Karl
A1  - Eichler, Sarah
A1  - Buhlert, Hermann
A1  - Kaminski, Stefan
A1  - Völler, Heinz
T1  - Cardiopulmonary exercise testing is predictive of return to work in cardiac patients after multicomponent rehabilitation
JF  - Clinical research in cardiology : official journal of the German Cardiac Society.
N2  - Return to work (RTW) is a pivotal goal of cardiac rehabilitation (CR) in patients after acute cardiac event. We aimed to evaluate cardiopulmonary exercise testing (CPX) parameters as predictors for RTW at discharge after CR. We analyzed data from a registry of 489 working-age patients (51.5 +/- A 6.9 years, 87.9 % men) who had undergone inpatient CR predominantly after percutaneous coronary intervention (PCI 62.6 %), coronary artery bypass graft (CABG 17.2 %), or heart valve replacement (9.0 %). Sociodemographic and clinical parameters, noninvasive cardiac diagnostic (2D echo, exercise ECG, 6MWT) and psychodiagnostic screening data, as well as CPX findings, were merged with RTW data from the German statutory pension insurance program and analyzed for prognostic ability. During a mean follow-up of 26.5 +/- A 11.9 months, 373 (76.3 %) patients returned to work, 116 (23.7 %) did not, and 60 (12.3 %) retired. After adjustment for covariates, elective CABG (HR 0.68, 95 % CI 0.47-0.98; p = 0.036) and work intensity (per level HR 0.83, 95 % CI 0.73-0.93; p = 0.002) were negatively associated with the probability of RTW. Exercise capacity in CPX (in Watts) and the VE/VCO2-slope had independent prognostic significance for RTW. A higher work load increased (HR 1.17, 95 % CI 1.02-1.35; p = 0.028) the probability of RTW, while a higher VE/VCO2 slope decreased (HR 0.85, 95 % CI 0.76-0.96; p = 0.009) it. CPX also had prognostic value for retirement: the likelihood of retirement decreased with increasing exercise capacity (HR 0.50, 95 % CI 0.30-0.82; p = 0.006).
KW  - Cardiac rehabilitation
KW  - Prognosis
KW  - Exercise capacity
KW  - Coronary disease
KW  - Social medicine
Y1  - 2016
U6  - https://doi.org/10.1007/s00392-015-0917-1
SN  - 1861-0684
SN  - 1861-0692
VL  - 105
SP  - 257
EP  - 267
PB  - Springer
CY  - Heidelberg
ER  -