Early Rehabilitation Patients Research Articles

Continuous Bilateral Transversus Thoracicmuscle Plane Block: An Analgesia Boon for Scoliotic Patients Undergoing Cardiac Surgery.

A person with thoracolumbar scoliosis for cardiac surgery presents with problems of restrictive lung disease with the additional risk of reduced lung compliance and respiratory complications compared to the other patients. Post-operative analgesia in the form of continuous bilateral transversus thoracic muscle plane block (TTMPB) may help such patients in early respiratory rehabilitation by decreasing the time to extubation, reducing the opioid requirement, and early initiation of physiotherapy decreasing the risk of complications.

Musculoskeletal Rehabilitation: New Perspectives in Postoperative Care Following Total Knee Arthroplasty Using an External Motion Sensor and a Smartphone Application for Remote Monitoring.

The number of total knee replacements performed annually is steadily increasing. Parallel options for postoperative care are decreasing, which reduces patient satisfaction. External devices to support physical rehabilitation and health monitoring will improve patient satisfaction and postoperative care. In a prospective, international multicenter study, patients were asked to use an external motion sensor and a smartphone application during the postoperative course of primary total knee arthroplasty. The collected data were transferred to a data platform, allowing for the real-time evaluation of patient data. In three participating centers, 98 patients were included. The general acceptance of using the sensor and app was high, with an overall compliance in study participation rate of up to 76%. The early results showed a significant improvement in the overall quality of life (p < 0.001) and significant reductions in pain (p < 0.01) and depression (p < 0.001). The early results of this clinical and multicenter study emphasize that there is a high interest in and acceptance of digital solutions in patients' treatment pathways. Motion sensor and smartphone applications support patients in early rehabilitation.

The unmet needs of patients in the early rehabilitation stage after lung cancer surgery: a qualitative study based on Maslow's hierarchy of needs theory.

This study aimed to explore the unmet needs of lung cancer patients in early rehabilitation, based on Maslow's hierarchy of needs theory. Information on the experiences of 20 patients was collected through semi-structured interviews. The interviews were conducted in the surgical nursing clinic within 1week of discharge from hospital. The data were analysed using a combination of deductive (theory-driven) and inductive (data-driven) methods, using Maslow's Hierarchy of Needs as a framework for identifying and organising themes. Patients had a mean age of 50.92years (SD 11.88); n = 11 (55%) were female. Major themes aligned with the dimensions of Maslow's hierarchy of needs model. Five major themes with 12 corresponding sub-themes emerged: (1) physiological needs, including "self-care and independence in life", "return to pre-operative status as soon as possible", "increase exercise under specialist guidance" and "reduce cough and pain and improve sleep quality"; (2) safety and security needs, such as "symptom management", "regulation of the emotions of worry and fear" and "access accurate treatment information"; (3) love and belonging needs, including "accompany family members" and "chat with friends";(4)Esteem needs: "live with dignity";(5) Self-actualization, such as "accept and submit to the reality of cancer" and "live meaningfully". The findings of this study indicated that there were many unmet needs for patients during the early recovery period after lung cancer surgery. An overview of the different areas of need identified in this study may guide future research and development of interventions to improve patients' quality of life during the home rehabilitation phase.

Propensity score-matched analysis of enhanced recovery after surgery in total hip arthroplasty for displaced femoral neck fractures

ObjectiveThe concept of enhanced recovery after surgery (ERAS) has been proposed in recent years, which indeed bring about evident convenience for the patients. This prospective cohort study was aimed to investigate the impact of ERAS on the clinical outcome of patients who undergoing total hip arthroplasty due to displaced femoral neck fractures. MethodsPatients in two periods were included in our research, before ERAS (n = 194) and after ERAS (n = 65). The clinical outcome, such as patient statistics, details of perioperative management, length of stay (LOS), pain, Harris hip score, in-hospital complications, and interim postoperative survival were collected. This retrospective observational study addressed confounding bias using propensity score matching (PSM) analysis. ResultsWith PSM, 55 pairs of well-matched patients were generated for comparison (conventional vs. ERAS). LOS decreased to 13.0 ± 3.2 days for the ERAS group, compared to 15.7 ± 3.5 days in the conventional group. VAS pain scores decreased significantly in both groups, and the decrease in the ERAS group was more significant than that in the conventional group at 3, 7, and 14 days postoperatively. The Harris scores of both groups significantly improved, but were better for the ERAS group than the conventional group at 7 and 14 days and 1 month postoperatively. However, no significant difference was observed at 6 months postoperatively. Additionally, the incidence of complications during hospitalization was lower in the ERAS group than that in the conventional group. No significant difference was observed in the medium-term survival between the two groups. ConclusionsERAS apparently benefit patients in early rehabilitation by reducing complications and shortening hospital stays but not for the long-term hip function or survival.

The diverse invitations to participate in early rehabilitation – A qualitative study of nurse-patient interactions in the intensive care unit

ObjectivesTo gain insight into the interaction between nurses and patients in early rehabilitation and the role of patient participation in this context. Research design and settingA qualitative study with a phenomenological-hermeneutic approach was conducted in two units/hospitals from January 2022 to January 2023, utilizing observations and video recordings of eight nurse/patient dyads combined with post observation interviews with the nurses. The study was analysed by systematic text condensation and video analysis, informed by interaction theory. FindingsTwo contrasting categories emerged: 1) Absent invitations: the nurse performed procedures without involving the patient; in other situations, the nurse informed the patient without requesting participation. Simultaneously, spontaneous patient movements were not acknowledged by the nurse. The nurses explained that this practice occurred due to time pressure, oversights, a lack of belief regarding patients’ capacities, the unit's culture and little training. 2) Invitations that strengthened participation: the nurse verbally requested activity that often resulted in an inadequate response, or bodily extended invitations that sometimes led to joint active movement. Patients were the most active participants when nurses combined verbal prompts, eye contact, physical handling, and dialogue. In the interviews, the nurses emphasized giving patients enough time to participate and repeatedly encouraged participation because the patient's condition and capacity constantly fluctuated. ConclusionInteractions that combine verbal and bodily invitations appear crucial for patient participation in early rehabilitation in the intensive care unit, emphasizing the importance of integrated tailored bodily communication. The nurses' lack of insight into and attention to the patient’s bodily potential for active movement combined with a paternalistic approach to the patient's situation may hinder patients' active participation. Implications for clinical practiceIntegrated forms of interaction that explore patients’ capacity and potential for participation should be employed in line with verbal communication. Developing competence in early rehabilitation should be emphasized in critical care nurses’ education and training.

Lactate changes during mobilization of intensive care patients : Aretrospective observational study

For intensive care patients the return to normal life is usually along and strenuous journey. In addition to the severity of the underlying disease, possible comorbidities, sedation and pain management as well as the use of various drugs together with the length of stay in the intensive care unit are factors that strongly influence the course of early rehabilitation and thus the functional outcome. Intensive care patients in particular are exposed to extreme stress during mobilization and often reach their cardiopulmonary stress limit. In order to determine such limits, lactate measurement is used in the performance diagnostics of athletes. In aretrospective study 20intensive care patients were mobilized up to their subjective maximum load capacity during physiotherapy (sitting on the edge of the bed n = 6, standing n = 12 and walking n = 2). The lactate value was determined from the routine arterial blood gas analysis and then an attempt was made to establish acorrelation between the subjectively perceived change in exercise load (Borg CR10) and the changes in lactate measurements. Changes in the sense of an increase in stress occurred in both in the Borg scale and in the lactate measurements. The subjective maximum load capacity increased on average by 4.85points (p = 0.13, 95% confidence interval, CI 4.58-5.12). In addition, asignificant mean increase in lactate by 10.8 mg/dl (p < 0.001, 95% CI 9.73-11.87) was observed. No positive correlation between the load-induced changes in Borg values and the development of lactate values was shown (Pearson correlation: r = 0.123). The subjective load increase in the Borg CR10 observed in all 20intensive care patients included in the study and the associated significant increase in lactate after mobilization, suggest that an efficient load in the sense of atraining-desired supercompensation was achieved through mobilization. The tendency towards acorrelation between the changes in Borg CR10 and the lactate values can be interpreted as an indication that the development of lactate values can also be used in intensive care patients to avoid overloading of patients in early rehabilitation.

Weaning in neurological and neurosurgical early rehabilitation-Results from the "WennFrüh" study of the German Society for Neurorehabilitation

Neurologisch-neurochirurgische Frührehabilitanden sind klinisch oft so schwer betroffen, dass sie neben der frührehabilitativen Behandlung auch von der mechanischen Beatmung entwöhnt werden müssen. In einer Umfrage der Deutschen Gesellschaft für Neurorehabilitation (DGNR) wurden neurologische Weaningzentren gebeten, Informationen zu Strukturmerkmalen ihrer Einrichtung, ihrer personellen und apparativen Ausstattung sowie basierend auf anonymen Daten zu Fallzahl und Behandlungsergebnis zur Verfügung zu stellen. Es nahmen 36 Weaningeinheiten aus 11 Bundesländern mit insgesamt 496 Betten teil. Von 2516 erfassten Weaningfällen im Jahr 2019 wurden 2097 (83,3 %) primär erfolgreich entwöhnt und nur 120 (4,8 %) mussten mit Heimbeatmung entlassen werden. Die Mortalität in dieser Stichprobe lag bei 11,0 % (n = 276). Die Erhebung zeigt, dass das prolongierte Weaning in der neurologisch-neurochirurgischen Frührehabilitation ein wichtiger und erfolgreicher Bestandteil der Versorgung schwerstkranker Patienten darstellt.

A COMPARATIVE STUDY OF PULMONARY FUNCTION TEST IN LAPAROTOMY AND LAPAROSCOPIC SURGERIES

Background and Aims- Respiratory complications account to majority of post-operative outcomes after abdominal surgeries. Data on exact prevalence and probability after different surgeries is scanty. Aim of our study is to evaluate pre and post operative differences objectively by using spirometry in patients undergoing upper abdominal laparoscopic and laparotomy surgeries. Methods- Seventy-one patients consecutively undergoing surgeries were enrolled, of which 36 underwent laparoscopic and rest open laparotomy. Patients were subjected to spirometry pre and post operatively, and FVC, FEV1, FEV1/FVC, VC were calculated. This cross sectional data was analysed using paired “t” test, Students “t” test and Chi square. Results- Preoperative FEV1,ERV, TLC, PEFR were significantly better in laparotomy than laparoscopic group (p value &lt;0.05). Age, sex and BMI were not significant determinants. Post operatively the laparoscopic group had better outcomes than laparotomy group. The exact mechanisms were not known but minimal scar length, lesser damage to diaphragm and muscles, younger age of patients in laparoscopic group and early postoperative rehabilitation could be possible explanations Conclusions- Present study demonstrates that laparoscopic surgeries has less adverse effects on postoperative pulmonary function than laparotomy surgeries. This may correlate with lower post op respiratory complications in laparoscopy group

Fat Mass Index Better Identifies Metabolic Syndrome: Insights from Patients in Early Outpatient Cardiac Rehabilitation.

Body mass index (BMI) does not differentiate fat and lean mass or the distribution of adipose tissue. The purpose of this study was to examine the prevalence of metabolic syndrome (MetS) among patients entering outpatient cardiac rehabilitation (CR) across fat mass index (FMI) categories compared with BMI. This retrospective cross-sectional study evaluated dual-energy x-ray absorptiometry in 483 CR patients from 1 January 2014, through 31 December 2017. Clinical data were extracted from the electronic health record. Patients were grouped by FMI and BMI categories. Mean (SD) age of patients was 64.3 (14) years. The normal FMI category had 15 patients; excess fat, 74; and obese, 384. In contrast, 93, 174, and 216 were in the normal, overweight, and obese BMI categories, respectively. Prevalence of MetS was 0 (0%) in normal, 5 (1%) in excess fat, and 167 (54%) in obese FMI, with 97% in the obese category. MetS prevalence was 4 patients (0.8%) in normal, 39 (8%) in overweight, and 129 (27%) in obese BMI categories, with 75% of MetS in the obese category. FMI more accurately classified CR patients with metabolically abnormal fat (p < 0.001). FMI is a more sensitive index than BMI for metabolically abnormal fat of outpatient CR patients.

MRSA screening in early neurological and neurosurgical rehabilitation

Strains of methicillin-resistant Staphylococcus aureus (MRSA) are of major economic and health-related importance to early neurological and neurosurgical rehabilitation. It is crucial to identify MRSA-carriers as soon as possible upon admission in order to prevent transmissions and to initiate contact precautions and decolonization. The present study focuses on validity of a polymerase chain reaction (PCR) test to identify MRSA genetic material from nasopharyngeal samples (BD MAX MRSA XT, BD Diagnostics, Heidelberg, Germany) of early neurological and neurosurgical rehabilitation patients. PCR-results were compared to gold standard (culture). In 2013, 66 patients were tested using PCR and incubation within one week after admission. Sensitivity of PCR was 84.6 %, specificity 86.6 %. Positive predictive value (PPV) was only 61.1 %, while negative predictive value was as high as 95.8 %. In 39 cases, PCR and subsequent culture were done within one day, leading to a sensitivity of 100 % and a specificity of 90.3 %. In this subgroup, PPV was 72.7 %, NPV 100 %. The results from the study suggest that incubation should quickly follow a positive PCR finding (within 24hours) in order to verify MRSA colonization. High NPV (95.8 resp. 100 %) indicate that PCR negative patients very likely are not colonized with MRSA. A positive PCR test is less reliable (due to false positive results) and should be followed by incubation in due course in order to avoid unnecessary contact precautions.

Influence of paroxysmal sympathetic hyperactivity (PSH) on the functional outcome of neurological early rehabilitation patients: a case control study

BackgroundParoxysmal Sympathetic Hyperactivity (PSH) is a frequently observed condition among critically ill patients on intensive care units. According to different studies, PSH is associated with worse recovery and increased mortality in acute-care facilities. In this monocentric, retrospective case-control study, we investigated whether this association also applies to post-acute neurological early rehabilitation.MethodsThe study included n = 387 patients, admitted to an intensive care or intermediate care unit within 1 year (2016). Among these, 97 patients showed clinical signs of PSH. For each patient with PSH, a patient without PSH was identified, controlling for age, gender, functional and respiratory status upon admission. However, for 25 patients with PSH, there was no suitable control patient fulfilling all defined matching criteria. Primary outcome was type of discharge, dichotomized into favorable (follow-up rehabilitation) and unfavorable outcome (all others). Secondary outcome measures were functional and respiratory status, number of secondary diagnoses, duration of treatment interruptions and length of stay at discharge.ResultsAbout 25% of neurological early rehabilitation patients showed clinical signs of PSH. A young age (OR = 0.94; CI = 0.91–0.97) and less severe PSH symptoms (OR = 0.79; CI = 0.69–0.90) were independent predictors of a favorable outcome. In addition, severity of PSH symptoms was associated with weaning duration, while the occurrence of PSH symptoms alone had no influence on most secondary outcome variables. The treatment on intermediate care units proved to be longer for patients with PSH symptoms, only.ConclusionsPatients with PSH represent a large group of neurological early rehabilitation patients. Overall, we did not find PSH-related differences in most of the examined outcome measures. However, severe PSH symptoms seem to be associated with poorer outcome and longer treatment on intermediate care units, in order to prevent possible complications.

Standardized nutritional supply versus individual nutritional assessment: Impact on weight changes, complications and functional outcome from neurological early rehabilitation

Approximately 55% of neurological and neurosurgical early rehabilitation (NNER) patients are in need of enteral nutrition, but long-term nutritional assessment of these critically ill patients is suboptimal. Therefore, this study analyzed the effect of an individual nutritional assessment on weight changes during rehabilitation and impact on complications and functional outcome. 170 NNER patients on enteral nutrition were enrolled in the study. According to the initial ward, patients were assigned to receive standardized enteral nutrition (n=107, control group) or an individual nutritional assessment (n=63, intervention group). Weight changes, complications, assessment of the functional outcome (Early Rehabilitation Index, Barthel Index, Early Rehabilitation Barthel Index) and the length of stay were recorded and compared between groups using non-parametric tests for non-paired samples (Mann-Whitney U test for metric data or the χ2 test for categorical data) or paired samples (Wilcoxon test). In addition, daily energy requirement was calculated and compared with daily intake. Correlation analysis by Spearman was performed to investigate linear relationship between weight changes and the difference of administered and calculated calories in both study groups. A weight loss was observed in the control group, whereas the weight of the intervention group remained stable over time. The difference between calculated and administered calories correlated with weight changes in the control group. Regarding complications during rehabilitation, control patients showed more frequently impaired diuresis. In addition, control patients were suffering longer from diarrhea than patients of the intervention group. Both groups improved in functional status to a comparable degree. Relationships between these improvements and weight changes or administered calories could not be found. Individual nutritional assessment had not an additional affect for the improvement of functional outcome or the prevention of complications. However, weight turned out to be more stable and signs of nutritional incompatibilities are less frequent among patients being treated with an individualized nutritional assessment.

Nutritional situation of enterally fed patients in neurological early rehabilitation and impact of nutritional status on functional outcome

Studies focusing on the nutritional status of neurological and neurosurgical early rehabilitation (NNER) patients are limited. The aim of the current study was to determine the nutritional status of NNER patients upon admission, to observe weight changes and to investigate the influence of nutritional status on complications and outcome. 109 enterally fed NNER patients were included in this prospective observational study. Weight changes, complications, neurological outcome scores (Early Rehabilitation Index [ERI], Barthel-Index [BI]) and the length of stay (LOS) were recorded. In addition, daily energy requirement was calculated and compared with daily intake to identify under-/optimally- and oversupplied patients. A general weight loss was observed in the study group. Weight changes during rehabilitation differed between men and women as well as between under- and oversupplied patients. Nutritional supply during rehabilitation had no influence on the LOS and the change of neurological outcome scores, but significant differences in the frequency of nosocomial infections was observed between under-/optimally- and oversupplied patients. The nutritional status (weight group on admission) had a crucial impact on neurological outcome scores, indicated by lower BI at discharge in normal-compared to underweight patients. In addition, underweight+undersupplied patients showed a significantly lower improvement of the BI than underweight+oversupplied patients. To the contrary, underweight+oversupplied patients had a higher BI improvement than underweight+optimally supplied patients. The nutritional status upon admission in combination with the nutritional supply during rehabilitation appears to have an impact on changes of neurological outcome scores.

Nutritional status of enterally nourished patients in neurological early rehabilitation

Rationale: Currently, the nutritional status of enterally nourished neurological and neurosurgical early rehabilitation (NNER) patients and its impact on rehabilitation outcome are poorly described. Therefore, the study aimed to investigate if the nutritional status on admission as well as weight changes during treatment is associated with the number and duration of complications during treatment and the clinical outcome.

Factors influencing weaning from mechanical ventilation in neurological and neurosurgical early rehabilitation patients.

Studies analyzing risk factors of weaning failure in neurological and neurosurgical early rehabilitation (NNER) patients are rare. The aim of this study was to identify clinical factors influencing the weaning of NNER patients. An observational, retrospective data analysis of a German multicenter study was performed. German neurological early rehabilitation centers. Inpatient ventilated NNER patients (N.=192) were enrolled in the study. Demographical data, main diagnosis, medical devices, special medical care and assessment instruments of functional abilities, consciousness and independence in activities of daily living were accrued and compared between patients with and without successful weaning. The prognostic power of factors associated with weaning success/failure was analyzed using binary logistic regression. In total, 75% of the patients were successfully weaned. Colonization with multi-drug resistant bacteria and the need for dialysis were independent predictors of weaning failure. Successfully weaned patients had a shorter length of stay, better functional outcome, and lower mortality than non-successfully weaned patients. Successfully weaned patients differ from patients with weaning failure in several clinical variables. All these variables are associated with the morbidity of the patient, indicating that the weaning process is strongly influenced by disease burden. Functional abilities, level of consciousness, independence in activities of daily living, colonization with multi-drug resistant bacteria, need for dialysis and disease duration might help to predict the weaning process of NNER.

A System Review: Effect of Robot-assisted Training on Improvement of Lower Extremities Function of Stroke Patients in Early Rehabilitation

A System Review: Effect of Robot-assisted Training on Improvement of Lower Extremities Function of Stroke Patients in Early Rehabilitation

Safety and efficacy of Cerebrolysin in motor function recovery after stroke: a meta-analysis of the CARS trials

This meta-analysis combines the results of two identical stroke studies (CARS-1 and CARS-2) assessing efficacy of Cerebrolysin on motor recovery during early rehabilitation. Cerebrolysin is a parenterally administered neuropeptide preparation approved for the treatment of stroke. Both studies had a prospective, randomized, double-blind, placebo-controlled design. Treatment with 30 ml Cerebrolysin once daily for 3 weeks was started 24–72 h after stroke onset. In addition, patients participated in a standardized rehabilitation program for 21 days that was initiated within 72 h after stroke onset. For both studies, the original analysis data were used for meta-analysis (individual patient data analysis). The combination of these two studies by meta-analytic procedures was pre-planned, and the methods were pre-defined under blinded conditions. The nonparametric Mann-Whitney (MW) effect size of the two studies on the ARAT score on day 90 indicated superiority of Cerebrolysin compared with placebo (MW 0.62, P < 0.0001, Wei-Lachin pooling procedure, day 90, last observation carried forward; N = 442). Also, analysis of early benefit at day 14 and day 21 by means of the National Institutes of Health Stroke Scale, which is regarded as most sensitive to early improvements, showed statistical significance (MW 0.59, P < 0.002). The corresponding number-needed-to-treat (NNT) for clinically relevant changes in early NIHSS was 7.1 (95% CI: 4 to 22). Cerebrolysin had a beneficial effect on motor function and neurological status in early rehabilitation patients after acute ischemic stroke. Safety aspects were comparable to placebo, showing a favourable benefit/risk ratio.

Weaning of neurological early rehabilitation patients from mechanical ventilation: a retrospective observational study.

There is little known about the factors influencing the weaning process of long-term mechanically ventilated patients in the neurological early rehabilitation. The aim of this study was to identify salient clinical and neurophysiological variables with impact upon weaning from mechanical ventilation during neurological and neurosurgical early rehabilitation. Observational, retrospective data analysis. The BDH-Clinic Hessisch Oldendorf in Northern Germany. A sample of 65 mechanically ventilated neurological and neurosurgical early rehabilitation patients. Most patients were suffering from brain disorders (stroke, brain hemorrhage, hypoxic brain damage). Clinical (ventilation hours, duration of daily therapy, Barthel Index [BI]) and neurophysiological data (evoked potentials) were analyzed retrospectively. The data was collected from the medical records of patients treated in our weaning facility. Weaning was successful in 92.3% (60/65) of all cases after a mean of 341.1 (±423.9) hours of ventilation; 2 patients (3.1%) died during the course of weaning and 3 (4.6%) were discharged on home ventilation. There was no significant correlation between ventilation hours and the amount of daily physio-, occupational or speech therapy, but there was a tendency towards a negative correlation of cognitive therapy with ventilation hours (rs=-0.234, P=0.088). Longer periods of ventilation correlated with poorer outcomes as measured by improvements in the BI (rs=-0.259, P<0.05). The more secondary diagnoses - a surrogate indicator of the total burden of morbidity - the more ventilation hours were necessary to wean the patient (rs=0.268, P<0.05). Patients isolated due to colonization with multi-drug resistant bacteria tended to require longer periods of ventilation than non-isolated persons (413.2 [±463.7] vs. 158.8 [±221.6], P=0.068). Data of evoked potentials did not correlate with ventilation hours. Most patients could be weaned from mechanical ventilation during early rehabilitation within approximately two weeks. Results from this study suggest that patients' morbidity (as indicated by the total number of secondary diagnoses) and isolation due to colonization with multi-drug resistant bacteria may be deleterious to the weaning process. In evaluation of the weaning prognosis of critically ill neurological and neurosurgical early rehabilitation patients, concomitant morbidity and colonization with multi-drug resistant bacteria should be taken into account.

Outcome of neurological early rehabilitation patients carrying multi-drug resistant bacteria: results from a German multi-center study

BackgroundColonization or infection with multi-drug resistant (MDR) bacteria is considered detrimental to the outcome of neurological and neurosurgical early rehabilitation patients.MethodsIn a German multi-center study, 754 neurological early rehabilitation patients were enrolled and and reviewed in respect to MDR status, length of stay (LOS) and the following outcome variables: Barthel Index (BI), Early Rehabilitation Index (ERI), Glasgow Outcome Score Extended (GOSE), Coma Remission Scale (CRS), Functional Ambulation Categories (FAC).ResultsThe mean age of the study population was 68.0 ± 14.8 years. Upon admission, the following prevalence for MDRs was observed: MRSA (methicillin resistant staphylococcus aureus) 7.0% (53/754), ESBL- (extended spectrum beta-lactamase) producing bacteria strains 12.6% (95/754), VRE (vancomycin resistant enterococci) 2.8% (21/754). Patients colonized or infected with MDR bacteria (MDR+) were significantly more frequently diagnosed with a critical illness polyneuropathy – CIP – than non-colonized (MDR-) patients: 29.0% vs. 14.8%. In addition, they were more frequently mechanically ventilated (MDR+: 55/138, 39.9%; MDR- 137/616, 22.2%). MDR+ patients were referred to rehabilitation earlier, had a longer LOS in early rehabilitation, lower BI on admission and at discharge, lower ERI on admission and lower CRS at discharge than MDR- patients. There was a highly significant correlation of the BI upon admission with the BI at discharge (rs = 0.492, p < 0.001). GOSE at discharge differed significantly between both groups (χ2-test, p < 0.01). Perhaps of greatest importance, mortality among MDR+ was higher in comparison to MDR- (18.1% vs. 7.6%).ConclusionsThe outcome of neurological early rehabilitation patients colonized or infected with MDR bacteria including MRSA or ESBL producing strains is significantly poorer than by non-colonized patients. There is some evidence that the poor outcome could be related to the higher morbidity and lower functional status upon admission.

Predictors of cognitive outcome in ventilated early rehabilitation patients

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 aprospective 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 75patients (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 anegative impact on cognitive ability. The model justifies 57% of the variance of the NMI (R2= 0.568) and therefore has ahigh 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, arapid decannulation procedure should also be an important therapeutic target, especially in alert patients.