1
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Michels G, John S, Janssens U, Raake P, Schütt KA, Bauersachs J, Barchfeld T, Schucher B, Delis S, Karpf-Wissel R, Kochanek M, von Bonin S, Erley CM, Kuhlmann SD, Müllges W, Gahn G, Heppner HJ, Wiese CHR, Kluge S, Busch HJ, Bausewein C, Schallenburger M, Pin M, Neukirchen M. [Palliative aspects in clinical acute and emergency medicine as well as intensive care medicine : Consensus paper of the DGIIN, DGK, DGP, DGHO, DGfN, DGNI, DGG, DGAI, DGINA and DG Palliativmedizin]. Med Klin Intensivmed Notfmed 2023; 118:14-38. [PMID: 37285027 PMCID: PMC10244869 DOI: 10.1007/s00063-023-01016-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 06/08/2023]
Abstract
The integration of palliative medicine is an important component in the treatment of various advanced diseases. While a German S3 guideline on palliative medicine exists for patients with incurable cancer, a recommendation for non-oncological patients and especially for palliative patients presenting in the emergency department or intensive care unit is missing to date. Based on the present consensus paper, the palliative care aspects of the respective medical disciplines are addressed. The timely integration of palliative care aims to improve quality of life and symptom control in clinical acute and emergency medicine as well as intensive care.
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Affiliation(s)
- Guido Michels
- Zentrum für Notaufnahme, Krankenhaus der Barmherzigen Brüder Trier, Medizincampus der Universitätsmedizin Mainz, Nordallee 1, 54292, Trier, Deutschland.
| | - Stefan John
- Medizinische Klinik 8, Paracelsus Medizinische Privatuniversität und Universität Erlangen-Nürnberg, Klinikum Nürnberg-Süd, 90471, Nürnberg, Deutschland
| | - Uwe Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - Philip Raake
- I. Medizinischen Klinik, Universitätsklinikum Augsburg, Herzzentrum Augsburg-Schwaben, Augsburg, Deutschland
| | - Katharina Andrea Schütt
- Klinik für Kardiologie, Angiologie und Internistische Intensivmedizin (Medizinische Klinik I), Uniklinik RWTH Aachen, Aachen, Deutschland
| | - Johann Bauersachs
- Klinik für Kardiologie und Angiologie, Zentrum Innere Medizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Thomas Barchfeld
- Medizinische Klinik II, Klinik für Pneumologie, Intensivmedizin und Schlafmedizin, Knappschaftskrankenhaus Dortmund, Klinikum Westfalen, Dortmund, Deutschland
| | - Bernd Schucher
- Abteilung Pneumologie, LungenClinic Großhansdorf, Großhansdorf, Deutschland
| | - Sandra Delis
- Helios Klinikum Emil von Behring GmbH, Berlin, Deutschland
| | - Rüdiger Karpf-Wissel
- Westdeutsches Lungenzentrum am Universitätsklinikum Essen gGmbH, Klinik für Pneumologie, Universitätsmedizin Essen Ruhrlandklinik, Essen, Deutschland
| | - Matthias Kochanek
- Medizinische Klinik I, Medizinische Fakultät und Uniklinik Köln, Center for Integrated Oncology (CIO) Cologne-Bonn, Universität zu Köln, Köln, Deutschland
| | - Simone von Bonin
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | | | | | - Wolfgang Müllges
- Neurologische Klinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Georg Gahn
- Neurologische Klinik, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe, Deutschland
| | - Hans Jürgen Heppner
- Klinik für Geriatrie und Geriatrische Tagesklinik, Klinikum Bayreuth - Medizincampus Oberfranken, Bayreuth, Deutschland
| | - Christoph H R Wiese
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
- Klinik für Anästhesiologie und Intensivmedizin, HEH Kliniken Braunschweig, Braunschweig, Deutschland
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Hans-Jörg Busch
- Universitätsklinikum, Universitäts-Notfallzentrum, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Claudia Bausewein
- Klinik und Poliklinik für Palliativmedizin, LMU Klinikum München, München, Deutschland
| | - Manuela Schallenburger
- Interdisziplinäres Zentrum für Palliativmedizin (IZP), Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Martin Pin
- Zentrale Interdisziplinäre Notaufnahme, Florence-Nightingale-Krankenhaus Düsseldorf, Düsseldorf, Deutschland
| | - Martin Neukirchen
- Interdisziplinäres Zentrum für Palliativmedizin (IZP), Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
- Klinik für Anästhesiologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
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Michels G, John S, Janssens U, Raake P, Schütt KA, Bauersachs J, Barchfeld T, Schucher B, Delis S, Karpf-Wissel R, Kochanek M, von Bonin S, Erley CM, Kuhlmann SD, Müllges W, Gahn G, Heppner HJ, Wiese CHR, Kluge S, Busch HJ, Bausewein C, Schallenburger M, Pin M, Neukirchen M. [Palliative aspects in clinical acute and emergency medicine as well as intensive care medicine: consensus paper of the DGIIN, DGK, DGP, DGHO, DGfN, DGNI, DGG, DGAI, DGINA and DGPalliativmedizin]. Pneumologie 2023; 77:544-549. [PMID: 37399837 DOI: 10.1055/a-2079-4210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
The timely integration of palliative medicine is an important component in the treatment of various advanced diseases. While a German S-3-guideline on palliative medicine exists for patients with incurable cancer, a recommendation for non-oncological patients and especially for palliative patients being treated in the emergency department or intensive care unit is missing to date. Based on the present consensus paper, the palliative care aspects of the respective medical disciplines are addressed. The timely integration of palliative care aims to improve quality of life and symptom control in clinical acute and emergency medicine as well as intensive care.
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Affiliation(s)
- Guido Michels
- Zentrum für Notaufnahme, Krankenhaus der Barmherzigen Brüder Trier, Medizincampus der Universitätsmedizin Mainz, Trier, Deutschland
| | - Stefan John
- Medizinische Klinik 8, Paracelsus Medizinische Privatuniversität & Universität Erlangen-Nürnberg, Klinikum Nürnberg-Süd, Nürnberg, Deutschland
| | - Uwe Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - Philip Raake
- I. Medizinischen Klinik, Universitätsklinikum Augsburg, Herzzentrum Augsburg-Schwaben, Augsburg, Deutschland
| | - Katharina Andrea Schütt
- Uniklinik RWTH Aachen, Klinik für Kardiologie, Angiologie und Internistische Intensivmedizin (Medizinische Klinik I), Aachen, Deutschland
| | - Johann Bauersachs
- Medizinische Hochschule Hannover, Klinik für Kardiologie und Angiologie, Zentrum Innere Medizin, Hannover, Deutschland
| | - Thomas Barchfeld
- Medizinische Klinik II, Klinik für Pneumologie, Intensivmedizin und Schlafmedizin, Knappschaftskrankenhaus Dortmund, Klinikum Westfalen, Deutschland
| | - Bernd Schucher
- LungenClinic Grosshansdorf, Abteilung Pneumologie, Großhansdorf, Deutschland
| | - Sandra Delis
- Helios Klinikum Emil von Behring GmbH, Berlin, Deutschland
| | - Rüdiger Karpf-Wissel
- Universitätsmedizin Essen Ruhrlandklinik, Westdeutsches Lungenzentrum am Universitätsklinikum Essen gGmbH, Klinik für Pneumologie, Essen, Deutschland
| | - Matthias Kochanek
- Medizinische Klinik I, Medizinische Fakultät und Uniklinik Köln, Center for Integrated Oncology (CIO) Cologne-Bonn, Uniklinik Köln, Köln, Deutschland
| | - Simone von Bonin
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | | | | | - Wolfgang Müllges
- Neurologische Klinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Georg Gahn
- Neurologische Klinik, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe, Deutschland
| | - Hans Jürgen Heppner
- Klinik für Geriatrie und Geriatrische Tagesklinik, Klinikum Bayreuth - Medizincampus Oberfranken, Bayreuth, Deutschland
| | - Christoph H R Wiese
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
- Klinik für Anästhesiologie und Intensivmedizin, HEH Kliniken Braunschweig, Braunschweig, Deutschland
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Hans-Jörg Busch
- Universitätsklinikum, Universitäts-Notfallzentrum, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Claudia Bausewein
- Klinik und Poliklinik für Palliativmedizin, LMU Klinikum München, München, Deutschland
| | - Manuela Schallenburger
- Interdisziplinäres Zentrum für Palliativmedizin (IZP), Heinrich Heine Universität Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Martin Pin
- Zentrale Interdisziplinäre Notaufnahme, Florence-Nightingale-Krankenhaus Düsseldorf, Düsseldorf, Deutschland
| | - Martin Neukirchen
- Interdisziplinäres Zentrum für Palliativmedizin (IZP), Heinrich Heine Universität Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
- Klinik für Anästhesiologie, Heinrich Heine Universität Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
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Michels G, John S, Janssens U, Raake P, Schütt KA, Bauersachs J, Barchfeld T, Schucher B, Delis S, Karpf-Wissel R, Kochanek M, von Bonin S, Erley CM, Kuhlmann SD, Müllges W, Gahn G, Heppner HJ, Wiese CHR, Kluge S, Busch HJ, Bausewein C, Schallenburger M, Pin M, Neukirchen M. [Palliative aspects in clinical acute and emergency medicine as well as intensive care medicine : Consensus paper of the DGIIN, DGK, DGP, DGHO, DGfN, DGNI, DGG, DGAI, DGINA and DGPalliativmedizin]. Anaesthesiologie 2023:10.1007/s00101-023-01315-y. [PMID: 37394611 DOI: 10.1007/s00101-023-01315-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
The timely integration of palliative medicine is an important component in the treatment of various advanced diseases. While a German S‑3-guideline on palliative medicine exists for patients with incurable cancer, a recommendation for non-oncological patients and especially for palliative patients presenting in the emergency department or intensive care unit is missing to date. Based on the present consensus paper, the palliative care aspects of the respective medical disciplines are addressed. The timely integration of palliative care aims to improve quality of life and symptom control in clinical acute and emergency medicine as well as intensive care.
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Affiliation(s)
- Guido Michels
- Zentrum für Notaufnahme, Krankenhaus der Barmherzigen Brüder Trier, Medizincampus Trier der Universitätsmedizin Mainz, Nordallee 1, 54292, Trier, Deutschland.
| | - Stefan John
- Medizinische Klinik 8, Paracelsus Medizinische Privatuniversität & Universität Erlangen-Nürnberg, Klinikum Nürnberg-Süd, Nürnberg, Deutschland
| | - Uwe Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - Philip Raake
- I. Medizinischen Klinik, Universitätsklinikum Augsburg, Herzzentrum Augsburg-Schwaben, Augsburg, Deutschland
| | - Katharina Andrea Schütt
- Klinik für Kardiologie, Angiologie und Internistische Intensivmedizin (Medizinische Klinik I), Uniklinik RWTH Aachen, Aachen, Deutschland
| | - Johann Bauersachs
- Klinik für Kardiologie und Angiologie, Zentrum Innere Medizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Thomas Barchfeld
- Medizinische Klinik II, Klinik für Pneumologie, Intensivmedizin und Schlafmedizin, Knappschaftskrankenhaus Dortmund, Klinikum Westfalen, Dortmund, Deutschland
| | - Bernd Schucher
- Abteilung Pneumologie, LungenClinic Grosshansdorf, Großhansdorf, Deutschland
| | - Sandra Delis
- Helios Klinikum Emil von Behring GmbH, Berlin, Deutschland
| | - Rüdiger Karpf-Wissel
- Universitätsmedizin Essen Ruhrlandklinik, Westdeutsches Lungenzentrum am Universitätsklinikum Essen gGmbH, Klinik für Pneumologie, Essen, Deutschland
| | - Matthias Kochanek
- Medizinische Klinik I, Medizinische Fakultät und Uniklinik Köln, Center for Integrated Oncology (CIO) Cologne-Bonn, Uniklinik Köln, Köln, Deutschland
| | - Simone von Bonin
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | | | | | - Wolfgang Müllges
- Neurologische Klinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Georg Gahn
- Neurologische Klinik, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe, Deutschland
| | - Hans Jürgen Heppner
- Klinik für Geriatrie und Geriatrische Tagesklinik, Klinikum Bayreuth - Medizincampus Oberfranken, Bayreuth, Deutschland
- Institut für Biomedizin des Alterns, Universität Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen-Nürnberg, Deutschland
- HELIOS Klinikum Schwelm, Schwelm, Deutschland
| | - Christoph H R Wiese
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
- Klinik für Anästhesiologie und Intensivmedizin, HEH Kliniken Braunschweig, Braunschweig, Deutschland
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Hans-Jörg Busch
- Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum (UNZ), Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Claudia Bausewein
- Klinik und Poliklinik für Palliativmedizin, LMU Klinikum München, München, Deutschland
| | - Manuela Schallenburger
- Interdisziplinäres Zentrum für Palliativmedizin (IZP), Heinrich Heine Universität Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Martin Pin
- Zentrale Interdisziplinäre Notaufnahme, Florence-Nightingale-Krankenhaus Düsseldorf, Düsseldorf, Deutschland
| | - Martin Neukirchen
- Interdisziplinäres Zentrum für Palliativmedizin (IZP), Heinrich Heine Universität Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
- Klinik für Anästhesiologie, Heinrich Heine Universität Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
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Michels G, John S, Janssens U, Raake P, Schütt KA, Bauersachs J, Barchfeld T, Schucher B, Delis S, Karpf-Wissel R, Kochanek M, von Bonin S, Erley CM, Kuhlmann SD, Müllges W, Gahn G, Heppner HJ, Wiese CHR, Kluge S, Busch HJ, Bausewein C, Schallenburger M, Pin M, Neukirchen M. [Palliative aspects in clinical acute and emergency medicine as well as intensive care medicine : Consensus paper of the DGIIN, DGK, DGP, DGHO, DGfN, DGNI, DGG, DGAI, DGINA and DGPalliativmedizin]. Z Gerontol Geriatr 2023:10.1007/s00391-023-02213-z. [PMID: 37394541 DOI: 10.1007/s00391-023-02213-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
The timely integration of palliative medicine is an important component in the treatment of various advanced diseases. While a German S‑3-guideline on palliative medicine exists for patients with incurable cancer, a recommendation for non-oncological patients and especially for palliative patients presenting in the emergency department or intensive care unit is missing to date. Based on the present consensus paper, the palliative care aspects of the respective medical disciplines are addressed. The timely integration of palliative care aims to improve quality of life and symptom control in clinical acute and emergency medicine as well as intensive care.
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Affiliation(s)
- Guido Michels
- Zentrum für Notaufnahme, Krankenhaus der Barmherzigen Brüder Trier, Medizincampus Trier der Universitätsmedizin Mainz, Nordallee 1, 54292, Trier, Deutschland.
| | - Stefan John
- Medizinische Klinik 8, Paracelsus Medizinische Privatuniversität & Universität Erlangen-Nürnberg, Klinikum Nürnberg-Süd, Nürnberg, Deutschland
| | - Uwe Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - Philip Raake
- I. Medizinischen Klinik, Universitätsklinikum Augsburg, Herzzentrum Augsburg-Schwaben, Augsburg, Deutschland
| | - Katharina Andrea Schütt
- Klinik für Kardiologie, Angiologie und Internistische Intensivmedizin (Medizinische Klinik I), Uniklinik RWTH Aachen, Aachen, Deutschland
| | - Johann Bauersachs
- Klinik für Kardiologie und Angiologie, Zentrum Innere Medizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Thomas Barchfeld
- Medizinische Klinik II, Klinik für Pneumologie, Intensivmedizin und Schlafmedizin, Knappschaftskrankenhaus Dortmund, Klinikum Westfalen, Dortmund, Deutschland
| | - Bernd Schucher
- Abteilung Pneumologie, LungenClinic Grosshansdorf, Großhansdorf, Deutschland
| | - Sandra Delis
- Helios Klinikum Emil von Behring GmbH, Berlin, Deutschland
| | - Rüdiger Karpf-Wissel
- Universitätsmedizin Essen Ruhrlandklinik, Westdeutsches Lungenzentrum am Universitätsklinikum Essen gGmbH, Klinik für Pneumologie, Essen, Deutschland
| | - Matthias Kochanek
- Medizinische Klinik I, Medizinische Fakultät und Uniklinik Köln, Center for Integrated Oncology (CIO) Cologne-Bonn, Uniklinik Köln, Köln, Deutschland
| | - Simone von Bonin
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | | | | | - Wolfgang Müllges
- Neurologische Klinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Georg Gahn
- Neurologische Klinik, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe, Deutschland
| | - Hans Jürgen Heppner
- Klinik für Geriatrie und Geriatrische Tagesklinik, Klinikum Bayreuth - Medizincampus Oberfranken, Bayreuth, Deutschland
- Institut für Biomedizin des Alterns, Universität Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen-Nürnberg, Deutschland
- HELIOS Klinikum Schwelm, Schwelm, Deutschland
| | - Christoph H R Wiese
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
- Klinik für Anästhesiologie und Intensivmedizin, HEH Kliniken Braunschweig, Braunschweig, Deutschland
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Hans-Jörg Busch
- Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum (UNZ), Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Claudia Bausewein
- Klinik und Poliklinik für Palliativmedizin, LMU Klinikum München, München, Deutschland
| | - Manuela Schallenburger
- Interdisziplinäres Zentrum für Palliativmedizin (IZP), Heinrich Heine Universität Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Martin Pin
- Zentrale Interdisziplinäre Notaufnahme, Florence-Nightingale-Krankenhaus Düsseldorf, Düsseldorf, Deutschland
| | - Martin Neukirchen
- Interdisziplinäres Zentrum für Palliativmedizin (IZP), Heinrich Heine Universität Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
- Klinik für Anästhesiologie, Heinrich Heine Universität Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
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Dellweg D, Siemon K, Höhn E, Barchfeld T, Köhler D. [Early Pulmonary Rehabilitation after Long Term Mechanical Ventilation]. Pneumologie 2021; 75:432-438. [PMID: 34116576 PMCID: PMC8195616 DOI: 10.1055/a-0978-1035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Einleitung
Unter Frührehabilitation versteht man eine frühzeitig bei- oder nach akuter Erkrankung einsetzende, rehabilitationsmedizinische Behandlung die im § 39SGB V verankert ist. Ziel dieser Untersuchung ist es, die Ergebnisqualität der pneumologischen Frührehabilitation zu untersuchen und darzustellen.
Methoden
Prospektive Erhebung von funktionellen Parametern, Beatmungsstatus und Entlass-Disposition in einer spezialisierten Abteilung für pneumologische Frührehabilitation über den Zeitraum von einem Jahr.
Ergebnisse
Von den 190 Patienten waren 179 (94,2 %) zuvor invasiv beatmet. Während einer Behandlungsdauer von 39 ± 17 Tagen stieg der FAM-Index von 84,4 ± 19,8 auf 118,5 ± 23,3 (Ci 30,9 – 37,3, Cohen’s d 1,58; p < 0,001), der Barthel-Index von 30,5 ± 13,8 auf 58,3 ± 16,2 (Ci 25,4 – 33,8, Cohen’s d 1,4; p < 0,001) und die Wegstrecke von 12,9 ± 40,1 m auf 131,4 ± 85,2 m (Ci 105,6 – 131,4 m, Cohen’s d 1,78; p < 0,001). Die Patienten wurden weniger häufig in eine weitere Anschlussheilbehandlung verlegt, wenn sie beatmet waren.
Diskussion
Patienten in der pneumologischen Frührehabilitation sind bei Aufnahme schwer kompromittiert, es lässt sich aber eine sehr gute Ergebnisqualität erzielen, die unabhängig davon zu sein scheint, ob der Patient eigenständig atmet oder mittels nicht-invasiver oder invasiver Beatmung versorgt wird. Die weitere Disposition dieser Patienten ist vor allem dann schwierig, wenn eine Beatmung vorliegt.
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Affiliation(s)
- D Dellweg
- Fachkrankenhaus Kloster Grafschaft GmbH, Abteilung Pneumologie I
| | - K Siemon
- Fachkrankenhaus Kloster Grafschaft GmbH, Abteilung Pneumologie I
| | - E Höhn
- Fachkrankenhaus Kloster Grafschaft GmbH, Abteilung Pneumologie I
| | - T Barchfeld
- Klinikum Westfalen, Knappschaftskrankenhaus Dortmund; Medizinische Klinik 2
| | - D Köhler
- Fachkrankenhaus Kloster Grafschaft GmbH, Abteilung Pneumologie I
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6
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Schönhofer B, Barchfeld T, Geiseler J, Heppner HJ. [Limits and Ethics of Mechanical Ventilation and Intensive Care Medicine in Old Age]. Pneumologie 2021; 75:142-155. [PMID: 33578435 DOI: 10.1055/a-1201-9007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Changing demography with more older people and more patients with chronic diseases as well as the progress of medicine leads to more geriatric patients treated in intensive care and requiring mechanical ventilation due to severe respiratory insufficiency.Frailty is associated with a more complicated intensive care stay, more difficult convalescence and with a higher mortality.In principle, geriatric expertise should be brought in as early as possible in the course of intensive care treatment for older patients in order to carry out adequate risk stratification and, depending on the extent of the impairment, to plan discharge or early rehabilitation.In older and frail patients preexisting chronic ventilatory insufficiency often leads to prolonged weaning. Patients with weaning failure should be referred to a specialized weaning center. Part of the assessment will be whether out-of-hospital invasive or non invasive ventilation is indicated and the wish of the patient.In intensive care the likelihood of a successful outcome and the patient's wishes must constantly be re-evaluated. This is particularly true in older patients. In addition it should be clarified with the patients and relatives what constitutes "success"; for example a patient may consider intensive care "worth it" if the ultimate goal is discharge to their own home but not if nursing home care and tracheostomy ventilation is the best that can be achieved. It may become apparent that a successful outcome is unlikely and then withdrawal of invasive ventilation is appropriate.
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Dellweg D, Siemon K, Höhn E, Barchfeld T, Köhler D. [Early pulmonary rehabilitation after long term mechanical ventilation]. Dtsch Med Wochenschr 2019; 144:e80-e86. [PMID: 31252437 DOI: 10.1055/a-0826-2296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The term early rehabilitation is defined as a rehabilitation that begins in the early phase after acute illness and is statutory positioned in § 39SGB V. Aim of this investigation is to describe the quality of outcome of pulmonary early rehabilitation. METHOD Prospective census of functional parameters, status of ventilation and discharge-disposition in a specialized unit for early pulmonary rehabilitation over a period of one year. RESULTS Out of 190 patients 179 (94.2 %) were previously invasively ventilated. During the treatment period of 39 ± 17 days, FAM-Index increased from 84.4 ± 19.8 to 118.5 ± 23.3 (Ci 30.9 - 37.3, Cohen'd 1.58; p < 0.001), Barthel-Index from 30.5 ± 13.8 to 58.3 ± 16.2 (Ci 25.4 - 33.8, Cohen's d 1.4; p < 0.001) six minute walking distance from 12.9 ± 40.1 m to 131.4 ± 85.2 m (Ci 105.6 - 131.4 m, Cohn's d 1.78; p < 0.001). Patients were less likely to be receive further post-discharge rehabilitation if they were ventilated. CONCLUSION Patients admitted to the early pulmonary rehabilitation unit were severely compromised, however quality of outcome was favourable and independent of the breathing status (spontaneously breathing vs. non-invasive ventilation or invasive ventilation). Finding discharge dispositions appeared to be more difficult if patients were ventilated.
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Affiliation(s)
- Dominic Dellweg
- Fachkrankenhaus Kloster Grafschaft GmbH, Abteilung Pneumologie I
| | - Karsten Siemon
- Fachkrankenhaus Kloster Grafschaft GmbH, Abteilung Pneumologie I
| | - Ekkehard Höhn
- Fachkrankenhaus Kloster Grafschaft GmbH, Abteilung Pneumologie I
| | - Thomas Barchfeld
- Klinikum Westfalen, Knappschaftskrankenhaus Dortmund; Medizinische Klinik 2
| | - Dieter Köhler
- Fachkrankenhaus Kloster Grafschaft GmbH, Abteilung Pneumologie I
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Westhoff M, Schönhofer B, Neumann P, Bickenbach J, Barchfeld T, Becker H, Dubb R, Fuchs H, Heppner HJ, Janssens U, Jehser T, Karg O, Kilger E, Köhler HD, Köhnlein T, Max M, Meyer FJ, Müllges W, Putensen C, Schreiter D, Storre JH, Windisch W. [Noninvasive Mechanical Ventilation in Acute Respiratory Failure]. Pneumologie 2015; 69:719-756. [PMID: 26649598 DOI: 10.1055/s-0034-1393309] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The non-invasive ventilation (NIV) is widespread in the clinical medicine and has attained meanwhile a high value in the clinical daily routine. The application of NIV reduces the length of ICU stay and hospitalization as well as mortality of patients with hypercapnic acute respiratory failure. Patients with acute respiratory failure in context of a cardiopulmonary edema should be treated in addition to necessary cardiological interventions with continuous positive airway pressure (CPAP) or NIV. In case of other forms of acute hypoxaemic respiratory failure it is recommended the application of NIV to be limited to mild forms of ARDS as the application of NIV in severe forms of ARDS is associated with higher rates of treatment failure and mortality. In weaning process from invasive ventilation the NIV reduces the risk of reintubation essentially in hypercapnic patients. A delayed intubation of patients with NIV failure leads to an increase of mortality and should therefore be avoided. With appropriate monitoring in intensive care NIV can also be successfully applied in pediatric patients with acute respiratory insufficiency. Furthermore NIV can be useful within palliative care for reduction of dyspnea and improving quality of life. The aim of the guideline update is, taking into account the growing scientific evidence, to outline the advantages as well as the limitations of NIV in the treatment of acute respiratory failure in daily clinical practice and in different indications.
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Affiliation(s)
| | | | - P Neumann
- Evangelisches Krankenhaus Göttingen-Weende gGmbH, Göttingen
| | | | - T Barchfeld
- Knappschaftskrankenhaus Dortmund, Klinikum Westfalen GmbH, Dortmund
| | - H Becker
- Asklepios Klinikum Barmbeck, Hamburg
| | - R Dubb
- Klinikum Stuttgart, Katharinenhospital, Stuttgart
| | - H Fuchs
- Uniklinik Freiburg, Freiburg
| | - H J Heppner
- Geriatrische Klinik, HELIOS Klinikum Schwelm, Schwelm
| | - U Janssens
- St.- Antonius-Hospital Eschweiler, Akad. Lehrkrankenhaus der RWTH Aachen, Eschweiler
| | - T Jehser
- Gemeinschaftskrankenhaus Havelhöhe, Berlin
| | - O Karg
- Asklepios Fachkliniken München-Gauting, Gauting
| | - E Kilger
- Ludwig-Maximilians-Universität, München
| | - H-D Köhler
- Fachkrankenhaus Klostergrafschaft, Schmallenberg
| | | | - M Max
- Centre Hospitalier de Luxembourg, Luxemburg
| | - F J Meyer
- Klinikum Harlaching, Städtisches Klinikum München, München
| | - W Müllges
- Universitätsklinikum Würzburg, Würzburg
| | | | - D Schreiter
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden
| | - J H Storre
- Lungenklinik, Kliniken der Stadt Köln gGmbH, Köln
| | - W Windisch
- Lungenklinik, Kliniken der Stadt Köln gGmbH, Köln
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Schönhofer B, Geiseler J, Dellweg D, Moerer O, Barchfeld T, Fuchs H, Karg O, Rosseau S, Sitter H, Weber-Carstens S, Westhoff M, Windisch W. S2k-Guideline "Prolonged Weaning". Pneumologie 2015; 69:595-607. [PMID: 26444135 DOI: 10.1055/s-0034-1392809] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
All mechanically ventilated patients must be weaned from the ventilator at some stage. According to an International Consensus Conference the criteria for "prolonged weaning" are fulfilled if patients fail at least 3 weaning attempts (i. e. spontaneous breathing trial, SBT) or require more than 7 days of weaning after the first SBT. This occurs in about 15 - 20 % of patients.Because of the growing number of patients requiring prolonged weaning a German guideline on prolonged weaning has been developed. It is an initiative of the German Respiratory Society (Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V., DGP) in cooperation with other societies (see acknowledgement) engaged in the field chaired by the Association of Scientific and Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF).This guideline deals with the definition, epidemiology, weaning categories, underlying pathophysiology, therapeutic strategies, the weaning unit, transition to out-of-hospital ventilation and therapeutic recommendations for end of life care. This short version summarises recommendations on prolonged weaning from the German guideline.
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Affiliation(s)
- B Schönhofer
- Prof. Dr. Bernd Schönhofer, Pneumologie, Internistische Intensivmedizin und Schlafmedizin KRH Klinikum Siloah-Oststadt-Heidehaus, Stadionbrücke 4, 30459 Hannover; E-Mail:
| | - J Geiseler
- Dr. Jens Geiseler, Asklepios Fachkliniken München-Gauting, Klinik für Intensiv-, Schlaf- und Beatmungsmedizin, Robert-Koch-Allee 2, 82131 Gauting; E-Mail:
| | - D Dellweg
- PD Dr. Dominic Dellweg, Fachkrankenhaus Kloster Grafschaft, Annostraße 1, 57392 Schmallenberg; E-Mail:
| | - O Moerer
- Prof. Dr. Onnen Moerer, Universitätsmedizin Göttingen, Klinik für Anästhesiologie, Zentrum Anästhesiologie, Rettungs- und Intensivmedizin, Robert-Koch Straße 40, 37075 Göttingen; E-Mail:
| | - T Barchfeld
- Dr. Thomas Barchfeld, Klinikum Westfalen GmbH, Knappschaftskrankenhaus Dortmund, Klinik für Pneumologie, Intensivmedizin und Schlafmedizin, Am Knappschaftskrankenhaus 1, 44309 Dortmund; E-Mail:
| | - H Fuchs
- Dr. Hans Fuchs, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Mathildenstraße 1, 79106 Freiburg; E-Mail:
| | - O Karg
- Dr. Ortrud Karg, Asklepios Fachkliniken München-Gauting, Leitung Medizinische Krankenhausorganisation, Robert-Koch-Allee 2, 82131 Gauting; E-Mail:
| | - S Rosseau
- Dr. Simone Rosseau, Charité Universitätsmedizin Berlin, Charité - Campus Mitte, Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charitéplatz 1, 10117 Berlin; E-Mail:
| | - H Sitter
- PD Dr. Helmut Sitter, Philips-Universität Marburg, Institut für Chirurgische Forschung, Baldingerstraße, 35033 Marburg; E-Mail:
| | - S Weber-Carstens
- PD Dr. Steffen Weber-Carstens, Charité Universitätsmedizin Berlin, Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin; E-Mail:
| | - M Westhoff
- Dr. Michael Westhoff, Lungenklinik Hemer, Klinik Pneumologie I, Theo-Funccius-Straße 1, 58675 Hemer; E-Mail:
| | - W Windisch
- Prof. Dr. Wolfram Windisch, Kliniken der Stadt Köln gGmbH, Abteilung Pneumologie, Ostmerheimer Straße 200, 51109 Köln; E-Mail:
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Heyse DC, Böckling S, Dellweg D, Siemon K, Köhler D, Barchfeld T, Höhn E. Vorbeatmungszeit, Verwirrtheit, Bicarbonat und Dauer des ersten Spontanatmungsversuches nach Übernahme von Patienten im prolongierten Weaning bestimmen hauptsächlich die Weaningzeit. Pneumologie 2015. [DOI: 10.1055/s-0035-1544597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Siemon K, Graw W, Höhn E, Barchfeld T, Schönhofer B, Köhler D, Dellweg D. Frührehabilitation nach Langzeitbeatmung – Ergebnisse einer Modelleinrichtung. Pneumologie 2015. [DOI: 10.1055/s-0035-1544888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Heyse DC, Dellweg D, Barchfeld T, Böckling S, Köhler D. Lungenfunktionsdaten von 314 erfolgreich entwöhnten Langzeitbeatmungspatienten. Pneumologie 2014. [DOI: 10.1055/s-0034-1367803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Dellweg D, Barchfeld T, Böckling S, Schürholz G, Figge M, Conze S, Kloske K, Köhler D. Monozentrische Outcomedaten von der prolongierten Beatmung von 2007 bis 2011. Pneumologie 2014. [DOI: 10.1055/s-0034-1367799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Schönhofer B, Geiseler J, Dellweg D, Moerer O, Barchfeld T, Fuchs H, Karg O, Rosseau S, Sitter H, Weber-Carstens S, Westhoff M, Windisch W. [Prolonged weaning: S2k-guideline published by the German Respiratory Society]. Pneumologie 2014; 68:19-75. [PMID: 24431072 DOI: 10.1055/s-0033-1359038] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Mechanical ventilation (MV) is an essential part of modern intensive care medicine. MV is performed in patients with severe respiratory failure caused by insufficiency of the respiratory muscles and/or lung parenchymal disease when/after other treatments, i. e. oxygen, body position, secretion management, medication or non invasive ventilation have failed.In the majority of ICU patients weaning is routine and does not present any problems. Nevertheless 40-50 % of the time during mechanical ventilation is spent on weaning. About 20 % of patients need continued MV despite resolution of the conditions which originally precipitated the need for MV.There maybe a combination of reasons; chronic lung disease, comorbidities, age and conditions acquired in ICU (critical care neuromyopathy, psychological problems). According to an International Consensus Conference the criteria for "prolonged weaning" are fulfilled if patients fail at least three weaning attempts or require more than 7 days of weaning after the first spontaneous breathing trial. Prolonged weaning is a challenge. An inter- and multi-disciplinary approach is essential for weaning success. Complex, difficult to wean patients who fulfill the criteria for "prolonged weaning" can still be successfully weaned in specialised weaning units in about 50% of cases.In patients with unsuccessful weaning, invasive mechanical ventilation has to be arranged either at home or in a long term care facility.This S2-guideline was developed because of the growing number of patients requiring prolonged weaning. It is an initiative of the German Respiratory Society (Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V., DGP) in cooperation with other societies engaged in the field.The guideline is based on a systematic literature review of other guidelines, the Cochrane Library and PubMed.The consensus project was chaired by the Association of Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF) based on a formal interdisciplinary process applying the Delphi-concept. The guideline covers the following topics: Definitions, epidemiology, weaning categories, pathophysiology, the spectrum of treatment strategies, the weaning unit, discharge from hospital on MV and recommendations for end of life decisions. Special issues relating to paediatric patients were considered at the end of each chapter.The target audience for this guideline are intensivists, pneumologists, anesthesiologists, internists, cardiologists, surgeons, neurologists, pediatricians, geriatricians, palliative care clinicians, nurses, physiotherapists, respiratory therapists, ventilator manufacturers.The aim of the guideline is to disseminate current knowledge about prolonged weaning to all interested parties. Because there is a lack of clinical research data in this field the guideline is mainly based on expert opinion.
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Schönhofer B, Geiseler J, Dellweg D, Moerer O, Barchfeld T, Fuchs H, Karg O, Rosseau S, Sitter H, Weber-Carstens S, Westhoff M, Windisch W. Prolongiertes Weaning. Pneumologie 2014. [DOI: 10.1055/s-0033-1359038 10.1055/s-0033-1359038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Barchfeld T, Dellweg D, Böckling S, Conze S, Kloske K, Schürholz G, Figge M, Köhler D. [Weaning from long-term mechanical ventilation: data of a single weaning center from 2007 to 2011]. Dtsch Med Wochenschr 2013; 139:527-33. [PMID: 24203587 DOI: 10.1055/s-0033-1349650] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Regional weaning centers play a more and more important role in the weaning process of long-term ventilated patients. The medical center Kloster Grafschaft is one of the oldest and largest centers in Germany. There is very little published data from larger weaning centers in Europe. METHODS From 2007 to 2011 all weaning patients were registered in a database. Additional information of the transferring hospitals was inquired. Prolonged weaning was defined by a period of at least 7 days of mechanical ventilation as well as three unsuccessful weaning trials. RESULTS Data from 867 of 916 registered patients could be analyzed. 71.1% could be successfully weaned from mechanical ventilation. All patients were suffering from a hypercapnic insufficiency as well as a variety of secondary diagnoses, on average 15.1 per patient. The median of age was 70 years, 62 % were male. Prior to hospital transfer patients had been ventilated for a median of 41 days. Time to successful removal of the artificial airway was 8 days according to the DRG code directive and 13.4 days when non-invasive ventilation (NIV) time was included. Of the 616 patients who could be successfully weaned, 42 % were discharged on NIV. Out of the 251 patients who could not be weaned, 107 were discharged. The remaining 144 (16.7 %) patients died, 33 % due to the primary underlying disease or a complication. 66 % of the deceased patients received palliative care. Patients with successful and unsuccessful weaning did not differ by age, by duration of mechanical ventilation or time until tracheostomy. Postoperative patients could be weaned more often than medical patients (p < 0.05). Discrimination between patients with successful and unsuccessful weaning was not possible by the point in time of the first spontaneous breathing trial in regard to the duration of ventilation but only by the duration of this trial after transfer to our unit (150 vs. 60 min; p < 10-6). The TISS-28 and the SAPS-II-Score did not differ between the two groups. Patients with successful weaning had less agitation according to the RASS-Score (0.47 vs. 0.15; p < 0.005). CONCLUSION It becomes apparent that in a specialized weaning center the majority of difficult to wean patients can be liberated in short time from mechanical ventilation.
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Affiliation(s)
- T Barchfeld
- Krankenhaus Kloster Grafschaft, Schmallenberg
| | - D Dellweg
- Krankenhaus Kloster Grafschaft, Schmallenberg
| | - S Böckling
- Krankenhaus Kloster Grafschaft, Schmallenberg
| | - S Conze
- Krankenhaus Kloster Grafschaft, Schmallenberg
| | - K Kloske
- Krankenhaus Kloster Grafschaft, Schmallenberg
| | - G Schürholz
- Krankenhaus Kloster Grafschaft, Schmallenberg
| | - M Figge
- Krankenhaus Kloster Grafschaft, Schmallenberg
| | - D Köhler
- Krankenhaus Kloster Grafschaft, Schmallenberg
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Dellweg D, Wachtel H, Höhn E, Pieper MP, Barchfeld T, Köhler D, Glaab T. In vitro validation of a Respimat® adapter for delivery of inhaled bronchodilators during mechanical ventilation. J Aerosol Med Pulm Drug Deliv 2011; 24:285-92. [PMID: 21870959 DOI: 10.1089/jamp.2011.0883] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Inhaled bronchodilators are frequently used in patients with chronic obstructive pulmonary disease (COPD). However, there has been no efficient way to administer the long-acting anticholinergic tiotropium to mechanically ventilated patients. The aim of this in vitro study was to compare the fine particle dose (FPD) output of a specifically designed adapter with other accessory devices for the delivery of bronchodilators using the Respimat® (RMT) inhaler by simulating the specific inhalation flow profiles of patients with COPD. METHODS Using characteristic flow profiles from COPD patients being weaned off mechanical ventilation, an in vitro study was performed analyzing the FPD achieved with different accessory devices (connectors, spacers, AeroTrachPlus valved holding chamber), which can be used to deliver drugs from pressurized metered dose inhalers (pMDI) and RMT inhalers to artificial airways. Fenoterol pMDI, tiotropium RMT, and a fixed-dose combination of salbutamol and ipratropium delivered by pMDI or RMT, were used as bronchodilators. Aerosols were collected by a next-generation impactor. RESULTS The RMT inhaler, combined with a new in-line adapter, was superior to other inhaler device connector or spacer combinations in FPD delivery during simulated mechanical ventilation (p<0.01). The outcome with the RMT inhaler/RMT adapter combination during simulation of mechanical ventilation was comparable to the measurements with the RMT/AeroTrachPlus valved holding chamber during simulation of spontaneous breathing. The delivery rates of the RMT adapter were not significantly affected by the administered bronchodilators or by the type of artificial airway (endotracheal or tracheostomy tube) employed. CONCLUSIONS The RMT inhaler combined with the prototype in-line adapter was better than the other accessory device combinations in fine particle deposition of inhaled bronchodilators during mechanical ventilation. Further research is required to determine the clinical relevance of these in vitro findings.
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Affiliation(s)
- Dominic Dellweg
- Hospital Kloster Grafschaft, Department of Respiratory and Critical Care Medicine, Schmallenberg, Germany
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Barchfeld T, Dellweg D, Böckling S, Köhler D. Liberales versus restriktives Transfusionsregime beim prolongierten Weaning von langzeitbeatmeten Patienten (WeanTrans-Trial) Vorstellung einer prospektiven, randomisierten Studie. Pneumologie 2011. [DOI: 10.1055/s-0031-1272274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Barchfeld T, Dellweg D, Siemon K, Köhler D. Therapiebegrenzung und -rückzug am Lebensende bei invasiv beatmeten Patienten; Daten aus einem großen Weaningzentrum. Pneumologie 2011. [DOI: 10.1055/s-0031-1272016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Barchfeld T, Getrey T, Dellweg D, Köhler D. Verlauf des Peak cough flows bei erfolgreich entwöhnbaren langzeitbeatmeten Patienten. Pneumologie 2010. [DOI: 10.1055/s-0030-1251195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Barchfeld T, Dellweg D, Siemon K, Conze S, Klauke M, Köhler D. Entwicklung der Ergebnisqualität eines Weaningzentrums vor und nach Einführung der Frührehabilitation nach Langzeitbeatmung. Pneumologie 2010. [DOI: 10.1055/s-0030-1251200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Siemon K, Ay M, Barchfeld T, Dellweg D, Heyse D, Haidl P, Köhler D. Erschwerte Diagnostik eines Wirbelkörperabszeß bei zusätzlich ausgeprägter beinbetonter Critical Illness Polyneuropathie – ein Fallbericht. Pneumologie 2009. [DOI: 10.1055/s-0029-1213876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dellweg D, Heyse D, Siemon K, Barchfeld T, Köhler D. Kontrollierte auto-adaptive nicht-invasive Beatmung – erste Erfahrungswerte aus der Praxis. Pneumologie 2009. [DOI: 10.1055/s-0029-1213822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Siemon K, Körber D, Barchfeld T, Dellweg D, Köhler D, Westhoff M. Beatmungspflichtigkeit – schwieriges Weaning bei unentdecktem trachealem Tumorein – ein Fallbericht. Pneumologie 2009. [DOI: 10.1055/s-0029-1213823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Barchfeld T, Dellweg D, Suchi S, Haidl P. [Frequency and influence of nosocomial pathogens on weaning outcome and in-hospital mortality in mechanically ventilated patients in a regional weaning centre in comparison of the years 2002 and 2006]. Pneumologie 2008; 62:361-6. [PMID: 18535981 DOI: 10.1055/s-2008-1038171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patients with nosocomial infections in the intensive care unit (ICU) seem to have a poor prognosis. In this retrospective cohort study we investigated the relationship between weaning outcome, in-hospital mortality and the microbiological proof of nosocomial pathogens from secretions in mechanically ventilated patients in the years 2002 and 2006. PATIENTS AND METHODS 311 patients with long term (> 14 days) invasive (tube or tracheostomy) mechanical ventilation (MV) were enrolled in to the study when they had failed at least two weaning attempts prior to transfer. Microbiological proof of nosocomial pathogens from secretions sampled by the bronchoscope and an X-ray of the chest on admission day (in the transferring ICU and in our ICU) was collected from all patients. RESULTS There was a significant decline of the weaning success rate between 2002 and 2006 (p = 0.001). The In-hospital mortality was higher in 2006 (p = 0.03). The microbiological proof of nosocomial pathogens had no influence on the weanability (exception: MRSA patients in 2002). In both years, patients with infiltrates on X-ray of the chest showed no increased mortality. But in 2006 it took longer to liberate these patients from invasive MV. In 2002 microbiological proof of pathogens was related to higher in-hospital mortality. In 2006, there was no difference concerning mortality in both groups. CONCLUSIONS Proof of nosocomial pathogens and infiltrates had no influence on the weanability of long-term mechanically ventilated patients. For in-hospital mortality, the results are contradictory.
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Affiliation(s)
- T Barchfeld
- Fachkrankenhaus Kloster Grafschaft, Pneumologie I, Schlaf- und Beatmungsmedizin, Intensivmedizin mit Frührehabilitation.
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Osseiran K, Barchfeld T, Dellweg D, Haidl P. [Cerebral arterial gas embolism as complication during the therapeutic endobronchial use of argon plasma coagulation]. Pneumologie 2008; 62:353-4. [PMID: 18535979 DOI: 10.1055/s-2008-1038133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In this case report, argon plasma coagulation (APC) was applied in a male individual to treat an occluding tumour of the right middle lobe bronchus with a post-stenotic atelectasis. During attempted recanalisation, the patient suffered a cerebral gas embolism as seen on CT scan, resulting in a distinct neurological deficit. We discuss the available data about cerebral gas embolism as a complication of APC and possibilities to avoid such complications.
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Affiliation(s)
- K Osseiran
- Fachkrankenhaus Kloster Grafschaft, Abteilung für Klinische Pneumologie und Innere Medizin, Schmallenberg.
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Köhler D, Dellweg D, Barchfeld T, Klauke M, Tiemann B. [Time-adaptive mode, a new ventilation form for the treatment of respiratory insufficiency--a self-learning system]. Pneumologie 2008; 62:527-32. [PMID: 18431701 DOI: 10.1055/s-2008-1038157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Hypercapnic respiratory failure is usually caused by an overload of the respiratory muscles (respiratory pump). After treatment of the underlying disease, mechanical ventilation will achieve optimal treatment success and higher degrees of respiratory muscle unloading will improve the outcome in terms of lower PaCO (2) levels and improved exercise performance. Routinely assisted modes are being used for ventilation, where the patient has to trigger the ventilator with his effort. Controlled ventilation is usually applied in sedated patients lacking spontaneous breathing efforts that are necessary to trigger the ventilator. Controlled ventilation, however, is feasible in awake patients but requires operator expertise. In this process, the respiratory pattern of the ventilator has to be adapted to the patient's own respiratory pattern. Changing conditions require a re-adaptation of parameters. In order to automatise this complex and time-consuming operation, a time-adaptive mode (TA-mode) has been developed. This programmed mode incorporates a self-learning algorithm, primarily detecting the patient's respiratory pattern. The software then calculates a matching flow profile using a motion equation that gives consideration to resistance and compliance. The operator has to pre-select allowed ranges of parameters (especially in- and expiratory pressures, IPAP and EPAP). After detection of a stable respiratory pattern (usually after 10 - 20 breaths), the ventilator will slowly increase the calculated flow profile and achieve controlled ventilation without irritating respiratory centres of the brain. Respiratory drive will cease usually within three to five minutes. Restart of the respiratory drive, for example, after coughing or during REM sleep with an altered respiratory pattern will be detected as ventilator fighting and the programme will return to the analysis algorithm again. After the respiratory pattern has become stable, the ventilator will take over ventilation again. The new mode has been validated in an accreditation study. For this purpose we selected 21 patients with stable hypercapnic respiratory failure, most of whom (20) had previously been ventilated with a controlled T-mode and only one patient had previously been ventilated with an assisted mode and adapted them to the new ventilator under polygraphic surveillance. Each time seven patients were adapted to a T-, ST- and TA-mode, respectively. Two patients, however, could not be adapted to ST-mode ventilation and were switched to TA-mode. PCO (2) values before and after ventilation were not significantly different between modes. Patient satisfaction was rated very good in 34 %, good in 45 % and non-gratifying in 21 % of cases ventilated with TA-mode. Consideration has to be given to the fact that patients previously had been receiving optimal ventilator treatment. The TA-mode is a self-learning system, capable of copying the patients own breathing pattern while awake, in order to achieve complete unloading of the respiratory muscles through controlled ventilation during a circumscribed period.
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Affiliation(s)
- D Köhler
- Krankenhaus Kloster Grafschaft, Schmallenberg.
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Fleimisch P, Barchfeld T, Köhler D. Haben Pleuraergüsse bei schwer entwöhnbaren, langzeitbeatmeten Patienten einen Einfluss auf den Weaningerfolg? Pneumologie 2008. [DOI: 10.1055/s-2008-1074385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Barchfeld T, Ay M, Koch T, Köhler D. Nekrotisierende Cholangitis: ein Krankheitsbild mit sehr schlechter Prognose bei einem Patienten mit Langzeitbeatmung. Pneumologie 2008. [DOI: 10.1055/s-2008-1074384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schönhofer B, Berndt C, Achtzehn U, Barchfeld T, Geiseler J, Heinemann F, Herth F, Kelbel C, Schucher B, Westhoff M, Köhler D. [Weaning from mechanical ventilation. A survey of the situation in pneumologic respiratory facilities in Germany]. Dtsch Med Wochenschr 2008; 133:700-4. [PMID: 18363187 DOI: 10.1055/s-2008-1067309] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OBJECTIVE The prevalence of difficult or prolonged weaning from mechanical ventilation is increasing because of a growing number of elderly patients with multiple diseases and pulmonary problems requiring mechanical ventilation. Intensive care units (ICU) are inclined to refer to specialized unit those patients who are difficult to wean. A nationwide survey of German facilities was conducted and this article reports the current state of weaning centers staffed by chest physicians. PATIENTS AND METHODS 38 centers participated in the survey, which was divided into 10 items, covering characteristics of the hospital, weaning strategies, patients and outcomes during 2006. The survey included 2718 patients in whom weaning was difficult or prolonged. Almost three quarters of patients were transferred to one of the weaning centers from the ICU of another hospital. RESULTS The weaning success rate was 66.4%. In 31,9 % of patients home mechanical ventilation was started after they had been weaned. The overall hospital mortality rate was 20.8%. There were major differences between individual centres concerning the number of patients, organization of the weaning unit and weaning strategies. CONCLUSIONS Weaning was successful in two thirds of patients who had been on prolonged mechanical ventilation and had then been transferred to weaning facilities staffed by chest physicians. These centres effectively improved the quality of care of patients on prolonged mechanical ventilation by avoiding long-term invasive ventilation and sparing cost-intensive ICU resources. The problems that still exist may be overcome by a network of weaning facilities.
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Affiliation(s)
- B Schönhofer
- Abteilung Pneumologie und Intern, Intensivmedizin, Klinikum Region Hannover.
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Abstract
BACKGROUND Tracheostomy decreases airway resistance and work of breathing. No comprehensive data are available on respiratory mechanics after tracheostomy decannulation. We evaluated respiratory mechanics after decannulation. METHODS Twenty-five patients with tracheostomy were included. Measurement of arterial blood gases, air-flow, and esophageal pressure during spontaneous breathing were evaluated. RESULTS Overall arterial blood gas parameters as well as flow and pressure measurements including work of breathing and airway resistance were not affected by the intervention. Inspiratory time fraction increased from 40.0 + or - 0.04 to 43% + or - 0.05% (p = .007). We observed marked individual differences. Postdecannulation change in work of breathing is best predicted by change in airway resistance (R = 0.869, R(2) = 0.755, p < .0001) CONCLUSION Inspiratory time increased after decannulation, and arterial blood gas levels and respiratory mechanics did not change for the whole cohort. Individual changes in work of breathing are considerable and correlate closely to changes in airway resistance.
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Affiliation(s)
- Dominic Dellweg
- Fachkrankenhaus Kloster Grafschaft, Annostr. 1, 57392 Schmallenberg, Germany.
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Dellweg D, Schonhofer B, Haidl PM, Barchfeld T, Wenzel MD, Appelhans P, Kohler D. Short-term effect of controlled instead of assisted noninvasive ventilation in chronic respiratory failure due to chronic obstructive pulmonary disease. Respir Care 2007; 52:1734-1740. [PMID: 18028564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Noninvasive positive-pressure ventilation (NPPV) unloads respiratory muscles. Spontaneous-breathing ventilation modes require patient effort to trigger the ventilator, whereas controlled modes potentially economize on patient triggering effort and thus achieve more complete respiratory muscle rest. Data on controlled NPPV have not been published to date. We hypothesize that controlled ventilation is feasible in patients with hypercapnic chronic obstructive pulmonary disease. METHODS We measured blood gas values, respiratory muscle strength, spontaneous breathing pattern, and lung function before and after a 3-month period of NPPV in 305 patients (213 male, mean +/- SD age 61.3 +/- 8.6 y). The subjects used a controlled NPPV mode when they could tolerate it. RESULTS Ninety-one percent of the patients were able to adapt to a controlled NPPV mode. In those patients, daytime P(CO(2)) decreased from 56.7 +/- 7.5 mm Hg to 47.5 +/- 6.6 mm Hg (p < 0.001) and P(O(2)) increased from 49.2 +/- 8.8 mm Hg to 56.2 +/- 8.5 mm Hg (p < 0.001). Their mean maximum inspiratory pressure increased from 42.3 +/- 16.9 cm H(2)O to 48.4 +/- 18.0 cm H(2)O (p < 0.001). Their mean vital capacity increased from 1.89 +/- 0.62 L to 1.99 +/- 0.67 L (p = 0.004). And their spontaneous breathing pattern became less rapid and shallow. CONCLUSIONS Controlled NPPV is feasible in patients with hypercapnic chronic obstructive pulmonary disease. We observed improved blood gas values, lung function, and inspiratory muscle strength.
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Affiliation(s)
- Dominic Dellweg
- Zentrum für Pneumologie, Beatmung, und Schlafmedizin Allergologie, Fachkrankenhaus Kloster Grafschaft, Annostrasse 1, 57392 Schmallenberg, Germany.
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Wenzel M, Kerl J, Dellweg D, Barchfeld T, Wenzel G, Köhler D. [Expiratory pressure reduction (C-Flex Method) versus fix CPAP in the therapy for obstructive sleep apnoea]. Pneumologie 2007; 61:692-5. [PMID: 17661239 DOI: 10.1055/s-2007-980075] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The REM star C-Flex (Fa. Respironics) was introduced in 2003. In contrast to the conventionel fix CPAP mode, the C-Flex mode is characterised by a pressure reduction at the beginning of expiration. In a randomised cross-over design, we investigated if this C-Flex-mode has advantages compared to the fix CPAP mode in terms of treatment quality and patient satisfaction. METHODS In this prospective randomised single-blinded cross-over study we investigated 20 patients with obstructive sleep apnoea treated with fix CPAP versus treatment with the C-Flex mode (level 2) for 6 weeks, respectively. We compared the polysomnographically measured quality of treatment and the subjective satisfaction of either form of therapy. Additionally, we measured long-term compliance of the C-Flex therapy in a 3-year follow-up with the integrated counter of the C-Flex devices. RESULTS The mean levels of pressure of the fix CPAP and the C-Flex therapies were 8.4 +/- 2.9 mbar in both groups. There was an identical quality of treatment in terms of respiratory events, arousal index, slow wave sleep and Epworth sleepiness scale. The compliance of nocturnal use of the C-Flex and the fix CPAP was identical (6.0 +/- 0.67 C-Flex use vs. 5.8 +/- 0.98 CPAP use [h/night]). The subjective satisfaction was higher in the C-Flex mode at the end of the study since 18 of 20 patients (90%) subjectively prefered the C-Flex mode because of the easier expiration. 19 patients received a C-Flex device for long-term therapy. The 3-year-follow-up showed a regular utilisation of the C-Flex by 16 of 19 (84.2%) of these patients (mean nocturnal use 6.0 +/- 0.9 h/night). 3 of the 19 patients (15.8%) did not use their C-Flex regulary. None of the patients has terminated therapy completely. CONCLUSION C-Flex mode and the conventional fix CPAP therapies show an equivalent treatment quality according to polysomnographic data. The expiratory pressure reduction compared to conventional CPAP was felt to be more comfortable by 90% of patients. The long-term-compliance as measured by regular use of the C-Flex device was 84.2% (16 out of 19 patients) after 3 years, these numbers are higher than published data on compliance with conventional CPAP therapy.
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Affiliation(s)
- M Wenzel
- Krankenhaus Kloster Grafschaft, Zentrum für Pneumologie, Beatmungs- und Schlafmedizin, 57392 Schmallenberg.
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Siemon K, Barchfeld T, Silberg B, Heinz M, Höhn E, Dellweg D, Haidl P, Köhler D. Lässt sich bei Frührehapatienten nach Langzeitbeatmung die 6min Wegstrecke bei Entlassung durch Funktionsuntersuchungen in Ruhe abschätzen? Pneumologie 2007. [DOI: 10.1055/s-2007-973186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Barchfeld T, Neifer C, Osseiran K, Kelbel C, Lorenz J, Friemann J, Köhler D. Aortendissektion: eine wichtige Differentialdiagnose bei oberer Einflussstauung. Pneumologie 2007. [DOI: 10.1055/s-2007-973326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Barchfeld T, Klauke M, Dellweg D, Tiemann B, Brandmeier M, Köhler D. Messungen zur Validierung eines nicht invasiven Beatmungsgerätes mit adaptivem Beatmungsmodus (TA-Modus). Pneumologie 2007. [DOI: 10.1055/s-2007-973164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Siemon K, Barchfeld T, Appelhans P, Heller D, Dellweg D, Haidl P, Köhler D. Funktionelle Verbesserung einer inoperablen Thoraxinstabilität durch Vakuumfixation; ein Fallbericht. Pneumologie 2007. [DOI: 10.1055/s-2007-973323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dellweg D, Barchfeld T, Klauke M, Köhler D. Stärkere Entlastung der Atemmuskulatur durch auto-adaptive kontrollierte nicht-invasive Beatmung. Pneumologie 2007. [DOI: 10.1055/s-2007-973365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Siemon K, Barchfeld T, Cersovsky A, Winterkamp S, Dellweg D, Wenzel M, Köhler D. Frührehabilitation nach Langzeitbeatmung. Evaluation nach 18 Monaten. Pneumologie 2007. [DOI: 10.1055/s-2007-973393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dellweg D, Barchfeld T, Wenzel M, Appelhans P, Köhler D. Kontrollierte nicht-invasive Beatmung bei COPD Patienten mit chronischer Hyperkapnie – Auswertung einer Heimbeatmungsdatenbank. Pneumologie 2007. [DOI: 10.1055/s-2007-973161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Respiratory failure as a result of overload and/or reduced capacity of the respiratory muscles is the most common cause of unsuccessful weaning and the need for long term mechanical ventilation. Chronic obstructive pulmonary disease (COPD) is the most common underlying cause leading into long term mechanical ventilation. The most important clinical parameter for fatigue of the respiratory muscles is the rapid shallow breathing index. Other essential factors which impact weaning failure, are the underlying diseases (e. g. neuromuscular disease or heart failure), micro- and macro aspiration, malnutrition, anemia and obesity. A protocol based strategy to discontinue mechanical ventilation and the use of weaning predictors are helpful. Nonetheless the experienced physician is irreplacable in the weaning process. Reconditioning of the respiratory muscles is the main focus during weaning after long term mechanical ventilation and all therapeutic measures should be targeted to unload the fatiguing respiratory muscles. With the widely used assisted ventilation modes, the inspiratory work of breathing is still significantly increased. Only controlled mechanical ventilation (pressure- or volume controlled), which may also be applied to unsedated patients when individually adapted, offers the best possible relief and recovery of the respiratory muscles. Additional strategies, such as the balancing of anemia, reduction of the respiratory drive with i. e. morphine derivates, oxygen therapy during spontaneous-breathing trials and supine position for patients with obesity contribute to the recovery. Particularly patients with chronic lung diseases with hypercapnia benefit from the use of non invasive ventilation (NIV) after extubation to prevent postextubation failure and even after tracheostomy. However, NIV should only be applied under close monitoring and in cooperative patients, always considering the limits of the method. Dying under mechanical ventilation in the end stage illness is still a challenge for all involved persons. In the end stage of their disease for some patients it is possible to discontinue mechanical ventilation so they can spend the last period of their lives on a normal ward or even at home.
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Affiliation(s)
- T Barchfeld
- Fachkrankenhaus Kloster Grafschaft, Schmallenberg.
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Siemon K, Barchfeld T, Haidl P, Stieglitz S, Herling S, Köhler D. Hat die Lokalanästhesie mit Acoin® Einfluss auf das bronchoskopisch gewonnene Keimspektrum? Pneumologie 2006. [DOI: 10.1055/s-2006-933853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Dellweg D, Barchfeld T, Haidl P, Appelhans P, Köhler D. Einfluss einer Pleuraergußpunktion auf die resistive Atemarbeit. Pneumologie 2006. [DOI: 10.1055/s-2006-933850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Siemon K, Barchfeld T, Cersovsky A, Haidl P, Köhler D. Frührehabilitation nach Langzeitbeatmung. Eine sinnvolle Einrichtung nach „erfolgreichem“ Weaning! Pneumologie 2006. [DOI: 10.1055/s-2006-934043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Dellweg D, Haidl P, Barchfeld T, Appelhans P, Köhler D. Einfluss des Atemmusters und der Körperposition auf die resistive inspiratorische Atemarbeit und den Sauerstoffverbrauch. Pneumologie 2006. [DOI: 10.1055/s-2006-934039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Dellweg D, Appelhans P, Barchfeld T, Haidl P, Köhler D. Vom Tracheostoma zum Platzhalter, eine differenzielle Messreihe der Atemarbeit verschiedener Systeme. Pneumologie 2005. [DOI: 10.1055/s-2005-864325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Barchfeld T, Klauke M, Appelhans P, Köbrich R, Köhler D. Eine neue Messmethode zur Bestimmung der Diffusionskapazität während der Beatmung: Validierung im Vergleich zur Single-Breath-Methode mit Lungengesunden. Pneumologie 2005. [DOI: 10.1055/s-2005-864417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wenzel M, Kerl J, Simon A, Dellweg D, Burkard H, Röhn U, Barchfeld T, Köhler D. C-Flex – Eine neue Therapiealternative zu CPAP in der Behandlung schlafbezogener obstruktiver Atemstörungen. Pneumologie 2005. [DOI: 10.1055/s-2005-864571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Barchfeld T, Haidl P, Dellweg D, Appelhans P, Schauerte S, Köhler D. Epidemiologie, Krankenhausmortalität und Weaning-Outcome in Abhängigkeit vom Lebensalter von schwer entwöhnbaren langzeitbeatmeten Patienten unter besonderer Berücksichtigung der nicht-invasiven Beatmung (NIV). Pneumologie 2005. [DOI: 10.1055/s-2004-831102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wenzel M, Barchfeld T, Osseiran K, Köhler D. Bronchoskopische Argon-Plasma-Koagulation bei Weaninghindernis durch subglottisches Granulationsgewebe. Pneumologie 2005. [DOI: 10.1055/s-2004-831123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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