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  - Flöel, Agnes
A1  - Werner, Cordula
A1  - Grittner, Ulrike
A1  - Hesse, Stefan
A1  - Jöbges, Michael
A1  - Knauss, Janet
A1  - Seifert, Michael
A1  - Steinhagen-Thiessen, Elisabeth
A1  - Goevercin, Mehmet
A1  - Dohle, Christian
A1  - Fischer, Wolfgang
A1  - Schlieder, Regina
A1  - Nave, Alexander Heinrich
A1  - Meisel, Andreas
A1  - Ebinger, Martin
A1  - Wellwood, Ian
T1  - Physical fitness training in Subacute Stroke (PHYS-STROKE) - study protocol for a randomised controlled trial
JF  - Trials
N2  - Background: 
Given the rising number of strokes worldwide, and the large number of individuals left with disabilities after stroke, novel strategies to reduce disability, increase functions in the motor and the cognitive domains, and improve quality of life are of major importance. Physical activity is a promising intervention to address these challenges but, as yet, there is no study demonstrating definite outcomes. Our objective is to assess whether additional treatment in the form of physical fitness-based training for patients early after stroke will provide benefits in terms of functional outcomes, in particular gait speed and the Barthel Index (co-primary outcome measures) reflecting activities of daily living (ADL). We will gather secondary functional outcomes as well as mechanistic parameters in an exploratory approach.
 Methods/Design: Our phase III randomised controlled trial will recruit 215 adults with moderate to severe limitations of walking and ADL 5 to 45 days after stroke onset. Participants will be stratified for the prognostic variables of "centre", "age", and "stroke severity", and randomly assigned to one of two groups. The interventional group receives physical fitness training delivered as supported or unsupported treadmill training (cardiovascular active aerobic training; five times per week, over 4 weeks; each session 50 minutes; total of 20 additional physical fitness training sessions) in addition to standard rehabilitation treatment. The control intervention consists of relaxation sessions (non-cardiovascular active; five times per week week, over 4 weeks; each session 50 minutes) in addition to standard rehabilitation treatment. Co-primary efficacy endpoints will be gait speed (in m/s, 10 m walk) and the Barthel Index (100 points total) at 3 months post-stroke, compared to baseline measurements. Secondary outcomes include standard measures of quality of life, sleep and mood, cognition, arm function, maximal oxygen uptake, and cardiovascular risk factors including blood pressure, pulse, waist-to-hip ratio, markers of inflammation, immunity and the insulin-glucose pathway, lipid profile, and others.
 Discussion: The goal of this endpoint-blinded, phase III randomised controlled trial is to provide evidence to guide post-stroke physical fitness-based rehabilitation programmes, and to elucidate the mechanisms underlying this intervention.
Y1  - 2014
U6  - https://doi.org/10.1186/1745-6215-15-45
SN  - 1745-6215
VL  - 15
PB  - BioMed Central
CY  - London
ER  -