Prolongiertes Weaning in der neurologisch-neurochirurgischen Frührehabilitation

Abstract

Prolonged weaning of patients with neurological or neurosurgery disorders is associated with specific characteristics, which are taken into account by the German Society for Neurorehabilitation (DGNR) in its own guideline. The current S2k guideline of the German Society for Pneumology and Respiratory Medicine is referred to explicitly with regard to definitions (e.g., weaning and weaning failure), weaning categories, pathophysiology of weaning failure, and general weaning strategies. In early neurological and neurosurgery rehabilitation, patients with central of respiratory regulation disturbances (e.g., cerebral stem lesions), swallowing disturbances (neurogenic dysphagia), neuromuscular problems (e.g., critical illness polyneuropathy, Guillain-Barre syndrome, paraplegia, Myasthenia gravis) and/or cognitive disturbances (e.g., disturbed consciousness and vigilance disorders, severe communication disorders), whose care during the weaning of ventilation requires, in addition to intensive medical competence, neurological or neurosurgical and neurorehabilitation expertise. In Germany, this competence is present in centers of early neurological and neurosurgery rehabilitation, as a hospital treatment. The guideline is based on a systematic search of guideline databases and MEDLINE. Consensus was established by means of a nominal group process and Delphi procedure moderated by the Association of the Scientific Medical Societies in Germany (AWMF). In the present guideline of the DGNR, the special structural and substantive characteristics of early neurological and neurosurgery rehabilitation and existing studies on weaning in early rehabilitation facilities are examined.Addressees of the guideline are neurologists, neurosurgeons, anesthesiologists, palliative physicians, speech therapists, intensive care staff, ergotherapists, physiotherapists, and neuropsychologists. In addition, this guideline is intended to provide information to specialists for physical medicine and rehabilitation (PMR), pneumologists, internists, respiratory therapists, the German Medical Service of Health Insurance Funds (MDK) and the German Association of Health Insurance Funds (MDS). The main goal of this guideline is to convey the current knowledge on the subject of "Prolonged weaning in early neurological and neurosurgery rehabilitation".

Dysphagie bei tracheotomierten Patienten nach Langzeitbeatmung

“…Entsprechend der S1-Leitlinie "Neurogene Dysphagien" der Deutschen Gesellschaft für Neurologie (DGN) [15] und der aktuellen S2k-Leitlinie "Prolongiertes Weaning in der neurologisch-neurochirurgischen Frührehabilitation" der Deutschen Gesellschaft für Neurorehabilitation (DGNR) [16] bieten sich hierfür prinzipiell 2 diagnostische Verfahren an.…”

Technische Entwicklungen zur Rehabilitation der Mobilität

“…Gerade im Weaning und der Rehabilitation von beatmeten Patienten spielt die systematische Vertikalisierung und Mobilisierung eine große Rolle [7]…”

Entstehung einer Leitlinie zur Beatmungsentwöhnung in der neurologisch-neurochirurgischen Frührehabilitation

“…Vergleicht man diese Quote mit Ergebnissen aus der neurologi schen (Akut-)Intensivmedizin bzw. pneumologischen Weaningzen tren, so scheint der Weaningerfolg bei Frührehabilitanden nicht schlechter zu sein [6,7].…”

“…Ungeachtet der zitierten Empfehlungen ist die Evidenzlage be züglich der Wirksamkeit definierter rehabilitativer Interventionen im Weaningprozess jedoch überaus schwach. Die vorhandene Evi denz lässt sich wie folgt zusammenfassen [7]:…”