TY - JOUR A1 - Salzwedel, Annett A1 - Heidler, Maria-Dorothea A1 - Meng, Karin A1 - Schikora, Martin A1 - Wegscheider, Karl A1 - Reibis, Rona Katharina A1 - Völler, Heinz T1 - Impact of cognitive performance on disease-related knowledge six months after multi-component rehabilitation in patients after an acute cardiac event JF - European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology N2 - Background Although associations between cardiovascular diseases and cognitive impairment are well known, the impact of cognitive performance on the success of patient education as a core component of cardiac rehabilitation remains insufficiently investigated so far. Design Prospective observational study in two inpatient cardiac rehabilitation centres between September 2014 and August 2015 with a follow-up six months after cardiac rehabilitation. Method At admission to and discharge from cardiac rehabilitation, the cognitive performance of 401 patients (54.5 ± 6.3 years, 80% men) following an acute coronary syndrome and/or coronary artery bypass graft was tested using the Montreal Cognitive Assessment. Patients’ disease-related knowledge was determined using a quiz (22 items for medical knowledge and 12 items for healthy lifestyle and behaviour) at both times and at follow-up. The change in knowledge after cardiac rehabilitation was analysed in multivariable regression models. Potentially influencing parameters (e.g. level of education, medication, cardiovascular risk factors, coronary artery bypass graft, comorbidities, exercise capacity) were considered. Results During cardiac rehabilitation, disease-related knowledge was significantly enhanced in both scales. At follow-up, the average level of medical knowledge was significantly reduced, while lifestyle knowledge remained at a stable level. The maintenance of knowledge after cardiac rehabilitation was predominantly predicted by prior knowledge, cognitive performance at discharge from cardiac rehabilitation and, in the case of medical knowledge, by coronary artery bypass graft. Conclusion Patient education in cardiac rehabilitation led to enhanced disease-related knowledge, but the maintenance of this essentially depended on patients’ cognitive performance, especially after coronary artery bypass graft. Therefore, patient education concepts in cardiac rehabilitation should be reconsidered and adjusted as needed. KW - Mild cognitive impairment KW - cardiac rehabilitation KW - patient education KW - coronary artery disease KW - secondary prevention Y1 - 2020 U6 - https://doi.org/10.1177/2047487318791609 SN - 2047-4873 SN - 2047-4881 VL - 26 IS - 1 SP - 46 EP - 55 PB - Sage Publ. CY - London ER - TY - JOUR A1 - Salzwedel, Annett A1 - Reibis, Rona Katharina A1 - Heidler, Maria-Dorothea A1 - Wegscheider, Karl A1 - Völler, Heinz T1 - Determinants of Return to Work After Multicomponent Cardiac Rehabilitation JF - Archives of Physical Medicine and Rehabilitation N2 - Objectives: To explore predictors of return to work in patients after acute coronary syndrome and coronary artery bypass grafting, taking into account cognitive performance, depression, physical capacity, and self-assessment of the occupational prognosis. Design: Observational, prospective, bicentric. Setting: Postacute 3-week inpatient cardiac rehabilitation (CR). Participants: Patients (N=401) <65 years of age (mean 54.5 +/- 6.3y), 80% men. Interventions: Not applicable. Main Outcome Measures: Status of return to work (RTW) 6 months after discharge from CR. Results: The regression model for RTW showed negative associations for depression (odds ratio 0.52 per SD, 95% confidence interval 0.36-0.76, P=.001), age (odds ratio 0.72, 95% confidence interval 0.52-1.00, P=.047), and in particular for a negative subjective occupational prognosis (expected incapacity for work odds ratio 0.19, 95% confidence interval 0.06-0.59, P=.004; unemployment odds ratio 0.08, 95% confidence interval 0.01-0.72, P=.024; retirement odds ratio 0.07, 95% confidence interval 0.01-0.067, P=.021). Positive predictors were employment before the cardiac event (odds ratio 9.66, 95% confidence interval 3.10-30.12, P<.001), capacity to work (fit vs unfit) at discharge from CR (odds ratio 3.15, 95% confidence interval 1.35-7.35, P=.008), and maximum exercise capacity (odds ratio 1.49, 95% confidence interval 1.06-2.11, P=.022). Cognitive performance had no effect. KW - Acute coronary syndrome KW - Cardiac rehabilitation KW - Coronary artery bypass grafting KW - Motivation KW - Rehabilitation KW - Return to work Y1 - 2019 U6 - https://doi.org/10.1016/j.apmr.2019.04.003 SN - 0003-9993 SN - 1532-821X VL - 100 IS - 12 SP - 2399 EP - 2402 PB - Elsevier CY - Philadelphia 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 - TY - JOUR A1 - Salzwedel, Annett A1 - Heidler, Maria-Dorothea A1 - Haubold, Kathrin A1 - Schikora, Martin A1 - Reibis, Rona Katharina A1 - Wegscheider, Karl A1 - Jöbgens, Michael A1 - Völler, Heinz T1 - Prevalence of mild cognitive impairment in employable patients after acute coronary event in cardiac rehabilitation JF - Vascular Health and Risk Management N2 - Introduction: Adequate cognitive function in patients is a prerequisite for successful implementation of patient education and lifestyle coping in comprehensive cardiac rehabilitation (CR) programs. Although the association between cardiovascular diseases and cognitive impairments (CIs) is well known, the prevalence particularly of mild CI in CR and the characteristics of affected patients have been insufficiently investigated so far. Methods: In this prospective observational study, 496 patients (54.5 ± 6.2 years, 79.8% men) with coronary artery disease following an acute coronary event (ACE) were analyzed. Patients were enrolled within 14 days of discharge from the hospital in a 3-week inpatient CR program. Patients were tested for CI using the Montreal Cognitive Assessment (MoCA) upon admission to and discharge from CR. Additionally, sociodemographic, clinical, and physiological variables were documented. The data were analyzed descriptively and in a multivariate stepwise backward elimination regression model with respect to CI. Results: At admission to CR, the CI (MoCA score < 26) was determined in 182 patients (36.7%). Significant differences between CI and no CI groups were identified, and CI group was associated with high prevalence of smoking (65.9 vs 56.7%, P = 0.046), heavy (physically demanding) workloads (26.4 vs 17.8%, P < 0.001), sick leave longer than 1 month prior to CR (28.6 vs 18.5%, P = 0.026), reduced exercise capacity (102.5 vs 118.8 W, P = 0.006), and a shorter 6-min walking distance (401.7 vs 421.3 m, P = 0.021) compared to no CI group. The age- and education-adjusted model showed positive associations with CI only for sick leave more than 1 month prior to ACE (odds ratio [OR] 1.673, 95% confidence interval 1.07–2.79; P = 0.03) and heavy workloads (OR 2.18, 95% confidence interval 1.42–3.36; P < 0.01). Conclusion: The prevalence of CI in CR was considerably high, affecting more than one-third of cardiac patients. Besides age and education level, CI was associated with heavy workloads and a longer sick leave before ACE. KW - cardiac rehabilitation KW - cognitive impairment KW - prevalence KW - acute coronary event KW - patient education Y1 - 2017 U6 - https://doi.org/10.2147/VHRM.S121086 SN - 1176-6344 SN - 1178-2048 VL - 13 SP - 55 EP - 60 PB - Dove Medical Press Ltd CY - Albany, Auckland ER - TY - GEN A1 - Salzwedel, Annett A1 - Heidler, Maria-Dorothea A1 - Haubold, Kathrin A1 - Schikora, Martin A1 - Reibis, Rona Katharina A1 - Wegscheider, Karl A1 - Jöbgens, Michael A1 - Völler, Heinz T1 - Prevalence of mild cognitive impairment in employable patients after acute coronary event in cardiac rehabilitation N2 - Introduction: Adequate cognitive function in patients is a prerequisite for successful implementation of patient education and lifestyle coping in comprehensive cardiac rehabilitation (CR) programs. Although the association between cardiovascular diseases and cognitive impairments (CIs) is well known, the prevalence particularly of mild CI in CR and the characteristics of affected patients have been insufficiently investigated so far. Methods: In this prospective observational study, 496 patients (54.5 ± 6.2 years, 79.8% men) with coronary artery disease following an acute coronary event (ACE) were analyzed. Patients were enrolled within 14 days of discharge from the hospital in a 3-week inpatient CR program. Patients were tested for CI using the Montreal Cognitive Assessment (MoCA) upon admission to and discharge from CR. Additionally, sociodemographic, clinical, and physiological variables were documented. The data were analyzed descriptively and in a multivariate stepwise backward elimination regression model with respect to CI. Results: At admission to CR, the CI (MoCA score < 26) was determined in 182 patients (36.7%). Significant differences between CI and no CI groups were identified, and CI group was associated with high prevalence of smoking (65.9 vs 56.7%, P = 0.046), heavy (physically demanding) workloads (26.4 vs 17.8%, P < 0.001), sick leave longer than 1 month prior to CR (28.6 vs 18.5%, P = 0.026), reduced exercise capacity (102.5 vs 118.8 W, P = 0.006), and a shorter 6-min walking distance (401.7 vs 421.3 m, P = 0.021) compared to no CI group. The age- and education-adjusted model showed positive associations with CI only for sick leave more than 1 month prior to ACE (odds ratio [OR] 1.673, 95% confidence interval 1.07–2.79; P = 0.03) and heavy workloads (OR 2.18, 95% confidence interval 1.42–3.36; P < 0.01). Conclusion: The prevalence of CI in CR was considerably high, affecting more than one-third of cardiac patients. Besides age and education level, CI was associated with heavy workloads and a longer sick leave before ACE. T3 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - 314 KW - cardiac rehabilitation KW - cognitive impairment KW - prevalence KW - acute coronary event KW - patient education Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-104113 SP - 55 EP - 60 ER - TY - JOUR A1 - Heidler, Maria-Dorothea A1 - Bidu, Laura A1 - Völler, Heinz A1 - Salzwedel, Annett T1 - Prädiktoren des kognitiven Outcomes beatmeter Frührehabilitationspatienten T1 - Predictors of cognitive outcome in ventilated early rehabilitation patients JF - Der Nervenarzt : Organ der Deutschen Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde ; Mitteilungsblatt der Deutschen Gesellschaft für Neurologie N2 - Hintergrund Patienten, die nach gescheitertem Weaning von der Intensivstation in die Frührehabilitation (FR) verlegt werden, weisen neben motorischen Einschränkungen oft auch Defizite in ihrer kognitiven Leistungsfähigkeit auf. Welche patientenseitigen Faktoren das kognitive Outcome am Ende der FR beeinflussen, ist noch unzureichend untersucht. Zielstellung Ermittlung von Prädiktoren auf das kognitive Leistungsvermögen initial beatmeter FR-Patienten. Methode Zwischen 01/2014 und 12/2015 wurden 301 Patienten (68,3 ± 11,4 Jahre, 67 % männlich) einer neurologischen Phase-B-Weaningstation konsekutiv in eine prospektive Beobachtungsstudie eingeschlossen. Zur Ermittlung möglicher Einflussfaktoren auf das kognitive Outcome (operationalisiert mittels Neuromentalindex [NMI]) wurden soziodemografische Daten, kritische Erkrankung, Komorbiditäten, Parameter zu Weaning und Dekanülierung sowie diverse Scores zur Ermittlung funktionaler Parameter erhoben und mittels ANCOVA multivariat ausgewertet. Ergebnisse Insgesamt 248 Patienten (82 %) konnten erfolgreich geweant werden, 155 (52 %) dekanüliert, 75 Patienten (25 %) verstarben, davon 39 (13 %) unter Palliativtherapie. Für die überlebenden Patienten (n = 226) konnten im finalen geschlechts- und altersadjustierten statistischen Modell unabhängige Prädiktoren des NMI bei Entlassung aus der FR ermittelt werden: Wachheit und erfolgreiche Dekanülierung waren positiv mit dem NMI assoziiert, während als kritische Erkrankungen hypoxische Hirnschädigungen, Hirninfarkte und Schädel-Hirn-Traumata einen negativen Einfluss auf die kognitive Leistungsfähigkeit hatten. Das berechnete Modell begründet 57 % der Varianz des NMI (R2 = 0,568) und weist damit eine hohe Erklärungsqualität auf. Schlussfolgerung Aufgrund des erhöhten Risikos für eine verminderte kognitive Leistungsfähigkeit zum Ende der FR sollten vor allem Patienten nach Hypoxie, Hirninfarkt und Schädel-Hirn-Trauma intensiv neuropsychologisch betreut werden. Da weiterhin eine erfolgreiche Dekanülierung mit verbesserten kognitiven Leistungen assoziiert ist, sollte – vor allem bei wachen Patienten – zudem ein zügiges Trachealkanülenmanagement im therapeutischen Fokus stehen. N2 - After weaning failure, patients who are transferred from intensive care units to early rehabilitation centers (ERC) not only suffer from motor deficits but also from cognitive deficits. It is still uncertain which patient factors have an impact on cognitive outcome at the end of early rehabilitation. Investigation of predictors of cognitive performance for initially ventilated early rehabilitation patients. A total of 301 patients (mean age 68.3 +/- 11.4 years, 67% male) were consecutively enrolled in an ERC for a prospective observational study between January 2014 and December 2015. To investigate influencing factors on cognitive outcome operationalized by the neuromental index (NMI), we collected sociodemographic data, parameters about the critical illness, comorbidities, weaning and decannulation as well as different functional scores at admission and discharge and carried out multivariate analyses by ANCOVA. Of the patients 248 (82%) were successfully weaned, 155 (52%) decannulated and 75 patients (25%) died of whom 39 (13%) were under palliative treatment. For the survivors (n = 226) we could identify independent predictors of the NMI at discharge from the ERC in the final sex and age-adjusted statistical model: alertness and decannulation were positively associated with the NMI whereas hypoxia, cerebral infarction and traumatic brain injury had a negative impact on cognitive ability. The model justifies 57% of the variance of the NMI (R-2 = 0.568) and therefore has a high quality of explanation. Because of increased risk of cognitive deficits at discharge of ERC, all patients who suffered from hypoxia, cerebral infarction or traumatic brain injury should be intensively treated by neuropsychologists. Since decannulation is also associated with positive cognitive outcome, a rapid decannulation procedure should also be an important therapeutic target, especially in alert patients. KW - Early rehabilitation KW - Ventilation KW - Decannulation KW - Cognition KW - Neuromental index KW - Frührehabilitation KW - Beatmung KW - Dekanülierung KW - Kognition KW - Neuromentalindex Y1 - 0201 U6 - https://doi.org/10.1007/s00115-017-0311-5 SN - 0028-2804 SN - 1433-0407 VL - 88 SP - 905 EP - 910 PB - Springer CY - New York ER - TY - JOUR A1 - Heidler, Maria-Dorothea T1 - Dysphagie bei tracheotomierten Patienten nach Langzeitbeatmung JF - Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : ains ; Organ der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin N2 - Unabhängig von der Art der kritischen Erkrankung haben tracheotomierte Patienten ein hohes Risiko, eine Schluckstörung zu entwickeln. Diese ist potenziell lebensbedrohlich, da sie zu Aspiration und Pneumonie führen kann. Vor einer oralen Nahrungsgabe sollte daher unbedingt eine Schluckdiagnostik mittels Bolusfärbetest und/oder FEES durchgeführt werden. Da ein physiologischer Luftstrom durch den Larynx und ein adäquater subglottischer Druck Schlüsselkomponenten eines effektiven Schluckaktes sind, sollte eine Oralisierung bei geblockter Trachealkanüle möglichst vermieden werden. Dysphagien sind eine häufige und potenziell lebensbedrohliche Komplikation bei langzeitbeatmeten tracheotomierten Patienten. Denn sie können zu Aspiration (Eindringen von Speichel und Nahrung in die Luftwege) und einer sich daraus entwickelnden Pneumonie führen [1]. Bevor diese Patienten auf orale Ernährung umgestellt und mit einem Sprechventil versehen werden, muss daher unbedingt die Schluckfähigkeit geprüft werden. N2 - Independent of the type of critical illness, tracheostomized patients have a high risk of developing a dysphagia. This is potentially life-threatening as it can lead to aspiration and pneumonia. It is therefore essential to perform swallowing diagnostics by means of a bolus dyeing test and/or FEES before oral feeding. Since a physiological airflow through the larynx and adequate subglottic pressure are key components of an effective swallowing act, oralisation should be avoided as far as possible with a blocked tracheal cannula. KW - Tracheotomie KW - Dysphagie KW - Aspiration KW - Schluckdiagnostik Y1 - 2019 U6 - https://doi.org/10.1055/a-0769-6551 SN - 0939-2661 SN - 1439-1074 VL - 54 IS - 3 SP - 218 EP - 222 PB - Thieme CY - Stuttgart ER - TY - JOUR A1 - Heidler, Maria-Dorothea T1 - Kognitive Störungen bei Patienten mit Herzerkrankungen T1 - Cognitive Deficits in Patiens with Cardiac Disease BT - ein Überblick BT - an Overview JF - Zeitschrift für Neuropsychologie N2 - Patienten mit Herzerkrankung leiden unter zahlreichen kognitiven Defiziten, die mit steigendem Alter und der Schwere der kardialen Erkrankung zunehmen. Die Genese kognitiver Defizite und ihre Wechselwirkung mit Herzerkrankungen ist multifaktoriell, potenziell sind sie jedoch durch eine adäquate medizinische Behandlung der Herzerkrankung modifizierbar. Oft haben neuropsychologische Störungen wie beeinträchtigte Aufmerksamkeits-, Gedächtnis- oder Exekutivfunktionen nachhaltige Auswirkungen auf die Lebensqualität und auf das Outcome kardiologischer Rehabilitationsmaßnahmen und können Herzerkrankungen verschlimmern (bspw. durch die Aufrechterhaltung eines ungesunden Lebensstils oder unzureichende Medikamentenadhärenz). Ein routinemäßig angewandtes neuropsychologisches Screening könnte helfen, kognitiv beeinträchtigte Patienten zu identifizieren, um medizinische und rehabilitative Maßnahmen optimieren zu können. N2 - Cognitive deficits in patients with cardiac disease are common and independent of the type of heart disease present. They increase with severity of the cardiac illness and the patient’s age. The genesis of cognitive impairments and their interactions with cardiac disease is multifactorial, though cognitive deficits are potentially reversible if they receive adequate medical treatment. Yet cognitive impairments like attention deficits, memory disorders, or impairment of executive functions can lower quality of life and the outcome of cardiac rehabilitation programs. They can even aggravate cardiac disease, for example, because of an unhealthy lifestyle or insufficient medication adherence. Routinely applied neuropsychological cognitive screening could help to identify affected patients to adapt medical and rehabilitative treatment. KW - Heart failure KW - coronary heart disease KW - cardiac arrhythmia KW - heart surgery KW - Herzinsuffizienz KW - Koronare Herzkrankheit KW - Herzrhythmussörung KW - Herzoperation Y1 - 2017 U6 - https://doi.org/10.1024/1016-264X/a000193 SN - 1016-264X SN - 1664-2902 VL - 28 IS - 1 SP - 33 EP - 44 PB - Hogrefe CY - Bern ER - TY - JOUR A1 - Heidler, Maria-Dorothea T1 - Clock test in patients with severe aphasia JF - Nervenheilkunde : Zeitschrift für interdisziplinäre Fortbildung N2 - Objective: How do patients with severe aphasia perform in the clock test? Methods:Ten patients with severe aphasia performed the clock test in two modes: copy a given clock (copy condition) and set a clock by drawing the clock hands, where a given digital display (11:10) should be transformed into an analogue display (time setting condition). Results: Not a single patient with severe aphasia was able to master any mode of the clock test. Both copy and time conditions were severely impaired by executive, conceptual, motoric visuospatial and apraxic disorders - impairments of language system were only one of numerous influencing factors. Conclusions and clinical relevance:The clock test measures and requires for its execution so many different cognitive, motoric and perceptual functions that it cannot adequately differentiate between patients with severe aphasia and other severe brain damage. KW - Clock test KW - aphasia KW - apraxia KW - executive functions Y1 - 2012 SN - 0722-1541 VL - 31 IS - 11 SP - 837 EP - 843 PB - Schattauer CY - Stuttgart ER - TY - GEN A1 - Völler, Heinz A1 - Heidler, Maria-Dorothea A1 - Rieck, Angelika A1 - Schikora, Martin A1 - Haubold, Kathrin A1 - Joebges, Michael A1 - Salzwedel, Annett T1 - Prevalence of mild cognitive impairment in patients after an acute coronary syndrome in cardiac rehabilitation T2 - European heart journal Y1 - 2016 SN - 0195-668X SN - 1522-9645 VL - 37 SP - 543 EP - 543 PB - Oxford Univ. Press CY - Oxford ER - TY - JOUR A1 - Heidler, Maria-Dorothea A1 - Bidu, Laura A1 - Friedrich, Nele A1 - Völler, Heinz T1 - Oral feeding of long-term ventilated patients with a tracheotomy tube. Underestimated danger of dysphagia JF - Medizinische Klinik, Intensivmedizin und Notfallmedizin N2 - In long-term mechanically ventilated patients, dysphagia is a common and potentially life-threatening complication, which can lead to aspiration and pneumonia. Nevertheless, many intensive care unit (ICU) patients are fed by mouth without evaluation of their deglutition capability. The goal of this work was to evaluate the prevalence of aspiration due to swallowing disorders in long-term ventilated patients who were fed orally in the ICU while having a blocked tracheotomy tube. In all, 43 patients participated-each underwent a fiberoptic investigation of deglutition on the day of admission to the rehabilitation clinic. A total of 65 % of the patients aspirated, 71 % of these silently. There were no associations between aspiration and any of the following: gender, indication for mechanical ventilation (underlying disease) or the duration of intubation and ventilation by tracheotomy tube. However, the association between aspiration and age was statistically significant (p = 0.041). Aspirating patients were older (arithmetic mean = 70 years, median = 74 years) than patients who did not aspirate (arithmetic mean = 66 years, median = 67 years). Intubation and add-on tracheotomies can lead to potentially life-threatening swallowing disorders that cause aspiration, independent of the underlying disease. Before feeding long-term mechanically ventilated patients by mouth, their ability to swallow needs to be investigated using fiberoptic endoscopic evaluation of swallowing (FEES) or a saliva dye test, if a cuff deflation and the use of a speaking valve are possible during spontaneous respiration. KW - Intubation KW - Tracheotomy KW - Ventilation KW - Endoscopy KW - Respiratory aspiration Y1 - 2015 U6 - https://doi.org/10.1007/s00063-014-0397-5 SN - 2193-6218 VL - 110 IS - 1 SP - 55 EP - 60 PB - Springer CY - New York ER -