Weaning of neurological early rehabilitation patients from mechanical Ventilation: A retrospective observational study

BACKGROUND: There is little known about the factors influencing the weaning process of long-term mechanically ventilated patients in the neurological early rehabilitation. AIM: 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. DESIGN: Observational, retrospective data analysis. SETTING: The BDH-Clinic Hessisch Oldendorf in Northern Germany. POPULATION: Asample of 65 mechanically ventilated neurological and neurosurgical early rehabilitation patients. Most patients were suffering from brain disorders (stroke, brain hemorrhage, hypoxic brain damage). METHODS: 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. RESULTS: 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 (r_s=-0.234, P=0.088). Longer periods of ventilation correlated with poorer outcomes as measured by improvements in the BI(r_s=-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 (r_s=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. CONCLUSIONS: 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. CLINICALREHABILITATION IMPACT: 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.