The influence of weaning duration on rehabilitative outcome in early neurological rehabilitation.
BACKGROUND
We investigated if longer weaning is associated with inferior rehabilitative outcome in critical illness polyneuropathy (CIP) and cerebrovascular diseases (CVD).


METHODS
We analysed retrospectively weaning protocols and medical histories of 171 tracheotomized patients with CIP and CVD. We assessed weaning durations (WD), independence in activities of daily living, as assessed by the functional independence measure (FIM), mortality rates and discharge modalities in each cohort. Weaning was performed using synchronized intermittent mandatory ventilation (SIMV) with Autoflow® and assisted spontaneous ventilation (ASV).


RESULTS
WD was significantly longer in CIP compared to CVD (p < 0.001). Despite shorter in-patient treatment and longer WD, patients with CIP acquired significantly greater gains of improvement than CVD (p = 0.015). Independent living at home was possible in 43% of patients with CIP and in 26% of CVD. Mortality was equal in both groups (13% vs. 6%, p > 0.05). Chronic obstructive pulmonary disease (COPD) showed a trend towards longer weaning durations in both entities (p = 0.06). Higher age significantly correlated with longer WD (p = 0.038, r = 0.16). Longer rehabilitation duration (RD) positively correlated with higher Delta-FIM (DFIM) in both entities (p = 0.006, r = 0.21).


CONCLUSIONS
Longer weaning and its partly negative influence on rehabilitative outcome can be compensated by longer in-patient rehabilitation in CIP and CVD.
Klinik Kipfenberg GmbH, Kipfenberg, Germany Neurologische Universitätsklinik Marburg, Philipps-Universität Marburg, Marburg, Germany.
Matthias
M
Ponfick
Klinik Kipfenberg GmbH, Kipfenberg, Germany.
Ralf
R
Wiederer
Klinik Kipfenberg GmbH, Kipfenberg, Germany.
Kathrin
K
Bösl
Klinik Kipfenberg GmbH, Kipfenberg, Germany.
Günter
G
Neumann
Klinik Kipfenberg GmbH, Kipfenberg, Germany.
Jitka
J
Lüdemann-Podubecka
Klinik Kipfenberg GmbH, Kipfenberg, Germany.
Hans-Jürgen
HJ
Gdynia
Klinik Kipfenberg GmbH, Kipfenberg, Germany Neurologische Universitätsklinik Marburg, Philipps-Universität Marburg, Marburg, Germany.
Dennis A
DA
Nowak
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002561:Cerebrovascular Disorders / Q000401:mortality / Q000534:rehabilitation*; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011115:Polyneuropathies / Q000401:mortality / Q000534:rehabilitation*; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality / Q000534:rehabilitation; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013997:Time Factors; D014140:Tracheotomy; D015300:Ventilator Weaning / Q000379:methods* / Q000401:mortality; D055815:Young Adult
Weaning; critical illness polyneuropathy; functional independence measure; outcome; rehabilitation; stroke