Neurologische Beatmungszentren

Groß, Martin; Pohl, Marcus; Rollnik, Jens D.; Dombrowski, Jörg; Müser, Thomas; Weigel, Anette; Wille, Andreas

doi:10.1007/978-3-662-59014-0_29

Cited by 2 publications

(4 citation statements)

References 22 publications

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“…Both the intervention group and the control group will receive standard care that is commonly used in intensive care medicine 2 15. Standard care consists of different methods to reduce the amount of secretion in the airways or to remove the secretion from the airways:…”

Section: Methods and Analysismentioning

confidence: 99%

“…Intervention and standard care Application of the MI-E device Cough Assist E70 (Koninklijke Philipps N.V., Amsterdam, Netherlands) will be carried out in the interventional group using the established clinical standards. 2 The MI-E first supplies the patient with positive pressure, via endotracheal tube, tracheal cannula or mask, and consecutively the lungs are inflated. The device then builds up negative pressure, which extracts the air from the lungs, thereby removing secretions from the airways.…”

Section: Open Accessmentioning

confidence: 99%

“…Severely affected neurological patients often suffer from cough insufficiency, either due to muscular weakness or impaired cough reflex. Ineffective cough can result in life-threatening retention of secretion, atelectasis and pneumonia 2. Comorbid dysphagia aggravates the retention of secretions; and even the presence of a cuff-securing endotracheal tube or tracheal cannula does not completely prevent aspiration of saliva 3…”

Section: Introductionmentioning

confidence: 99%

“…Ineffective cough can result in life-threatening retention of secretion, atelectasis and pneumonia. 2 Comorbid dysphagia aggravates the retention of secretions; and even the presence of a cuff-securing endotracheal tube or tracheal cannula does not completely prevent aspiration of saliva. 3 Due to a lack of alternatives in the management of insufficient cough and retention of secretion, the application of mechanical insufflation-exsufflation (MI-E) in patients with neuromuscular disease or spinal cord injury has become an international standard.…”

Section: Introductionmentioning

confidence: 99%

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Effect of mechanical insufflation-exsufflation for ineffective cough on weaning duration in diseases of the peripheral or central nervous system (MEDINE): study protocol for a randomised controlled trial in a neurological weaning centre

et al. 2023

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IntroductionPatients with neurological or neurosurgical disease can suffer from impaired cough, which may result in life-threatening retention of tracheobronchial secretions, atelectasis, pneumonia and finally death. Due to a lack of alternatives and pathophysiological plausibility, the application of mechanical insufflation-exsufflation (MI-E) has already become international standard care in neuromuscular disease and spinal cord injury although a lack of evidence for efficacy. High-quality studies to support the use of MI-E in neurological and neurosurgical patients during weaning from mechanical ventilation are missing. The goal of this exploratory study is to display the effect size of MI-E intervention on the duration of mechanical ventilation and additional outcomes.Methods and analysisOne hundred adult patients with a cough deficiency or retention of secretion admitted to a neurological intensive care unit (ICU) are planned to be recruited for this randomised controlled trial. Patients are randomised 1:1 to receive either MI-E or best standard care. Observation will take place until discharge from the hospital, death or end of the study period. The primary endpoint of this trial is the duration of mechanical ventilation from randomisation until successful weaning. The outcome will be analysed with Kaplan-Meier estimation and competing risks analyses. Secondary endpoint is the proportion of patients with successful weaning. Further outcomes will include the incidence of hospital-acquired pneumonia, mortality, decannulation rate, length of stay on the ICU and the total score of the Glasgow Coma Scale.Ethics and disseminationThe study was approved by the Medical Ethics Committee of the University of Oldenburg. The findings of this study will be submitted for publication in a peer-reviewed journal.Trial registration numberDRKS00020981.

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Section: Methods and Analysismentioning

confidence: 99%

Section: Open Accessmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effect of mechanical insufflation-exsufflation for ineffective cough on weaning duration in diseases of the peripheral or central nervous system (MEDINE): study protocol for a randomised controlled trial in a neurological weaning centre

et al. 2023

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How to improve the quality of care for people on home mechanical ventilation from the perspective of healthcare professionals: a qualitative study

Klingshirn

Gerken

Hofmann

et al. 2021

BMC Health Serv Res

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Background The rapid increase in the use of home mechanical ventilation (HMV) for people with chronic respiratory failure poses extreme challenges for the healthcare system. People on HMV have complex care needs and require support from an interprofessional team. In Germany, HMV is criticised for inadequate quality standards, particularly in outpatient intensive care practice. The objective of this study was to describe the quality of care for people on outpatient HMV in Germany, Bavaria and provide recommendations for improvement from the perspective of healthcare professionals (HCPs). Methods Semi-structured qualitative telephone interviews with HCPs (i.e., nurses, equipment providers, therapists, and physicians) were analysed using the framework method. The quality framework of Health Improvement Scotland (HIS), which aims to improve the quality of person-centred care, was used to build a deductive analysis matrix. The framework includes the three key areas: (1) Outcomes and impact, (2) Service delivery, and (3) Vision and leadership. The domains (meta-codes) and quality indicators (sub-codes) of the quality framework were used for deductive coding. Results Overall, 87 HCPs (51 female, mean age of 44.3 years, mean professional experience in HMV of 9.4 years) were interviewed (mean duration of 31 min). There was a complex interaction between the existing health care system (Outcomes and impact, 955 meaning units), the delivery of outpatient intensive care (Service delivery, 939 meaning units), and improvement-focused leadership (Vision and leadership, 70 meaning units) that influenced the quality of care for people on HMV. The main barriers were an acceleration in transition management, a neglect of weaning potential, a shortage of qualified professionals and missing quality criteria. The central recommendations for promoting person-centred care were training and supervision of staff and an inspiring leadership. An integrated care structure supporting medical home visits and outpatient rehabilitation should be developed. Conclusion This study describes a heterogeneous and partly deficient care situation for people on HMV, but demonstrates that high quality care is possible if person-centred care is successfully implemented in all areas of service provision. The recommendations of this study could inform the development of a person-centred integrated care structure for people on HMV.

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Neurologische Beatmungszentren

Cited by 2 publications

References 22 publications

Effect of mechanical insufflation-exsufflation for ineffective cough on weaning duration in diseases of the peripheral or central nervous system (MEDINE): study protocol for a randomised controlled trial in a neurological weaning centre

Effect of mechanical insufflation-exsufflation for ineffective cough on weaning duration in diseases of the peripheral or central nervous system (MEDINE): study protocol for a randomised controlled trial in a neurological weaning centre

How to improve the quality of care for people on home mechanical ventilation from the perspective of healthcare professionals: a qualitative study

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