title: [Predictors of cognitive outcome in ventilated early rehabilitation patients].
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  Investigation of predictors of cognitive performance for initially ventilated early rehabilitation patients.
  
  
  METHODS
  A total of 301 patients (mean age 68.3 ± 11.4 years, 67% male) were consecutively enrolled in an ERC for a prospective 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.
  
  
  RESULTS
  Of the patients 248 (82%) were successfully weaned, 155 (52%) decannulated and 75 patients (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 a negative impact on cognitive ability. The model justifies 57% of the variance of the NMI (R2= 0.568) and therefore has a high quality of explanation.
  
  
  CONCLUSIONS
  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, a rapid decannulation procedure should also be an important therapeutic target, especially in alert patients.
authors.affiliation: Professur für Rehabilitationswissenschaften, Universität Potsdam, Am Neuen Palais 10, Haus 12, 14469, Potsdam, Deutschland. mheidler@uni-potsdam.de.|Brandenburg Klinik, Bernau, Deutschland. mheidler@uni-potsdam.de.
authors.forename: M-D
authors.initials: MD
authors.lastname: Heidler
authors.affiliation: Brandenburg Klinik, Bernau, Deutschland.
authors.forename: L
authors.initials: L
authors.lastname: Bidu
authors.affiliation: Professur für Rehabilitationswissenschaften, Universität Potsdam, Am Neuen Palais 10, Haus 12, 14469, Potsdam, Deutschland.
authors.forename: H
authors.initials: H
authors.lastname: Völler
authors.affiliation: Professur für Rehabilitationswissenschaften, Universität Potsdam, Am Neuen Palais 10, Haus 12, 14469, Potsdam, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Salzwedel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001925:Brain Damage, Chronic / Q000175:diagnosis / Q000401:mortality / Q000534:rehabilitation*; D003072:Cognition Disorders / Q000175:diagnosis / Q000401:mortality / Q000534:rehabilitation*; D061345:Early Medical Intervention; D005260:Female; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D009460:Neurologic Examination; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D018570:Risk Assessment; D014140:Tracheotomy; D015300:Ventilator Weaning
keywords: Cognition; Decannulation; Early rehabilitation; Neuromental index; Ventilation