[Dysphagia in Tracheostomized Patients after Long-Term Mechanical Ventilation - Become Sensitive to Reduced Pharyngo-Laryngeal Sensitivity]. / Dysphagie bei tracheotomierten Patienten nach Langzeitbeatmung.

Independent of the type of critical illness, tracheostomized patients have a high risk of developing a dysphagia. This is potentially life-threatening as it can lead to aspiration and pneumonia. It is therefore essential to perform swallowing diagnostics by means of a bolus dyeing test and/or FEES before oral feeding. Since a physiological airflow through the larynx and adequate subglottic pressure are key components of an effective swallowing act, oralisation should be avoided as far as possible with a blocked tracheal cannula.

[Dysphagia in Tracheostomized Patients after Long-Term Mechanical Ventilation - Become Sensitive to Reduced Pharyngo-Laryngeal Sensitivity]. / Dysphagie bei tracheotomierten Patienten nach Langzeitbeatmung.

Independent of the type of critical illness, tracheostomized patients have a high risk of developing a dysphagia. This is potentially life-threatening as it can lead to aspiration and pneumonia. It is therefore essential to perform swallowing diagnostics by means of a bolus dyeing test and / or FEES before oral feeding. Since a physiological airflow through the larynx and adequate subglottic pressure are key components of an effective swallowing act, oralisation should be avoided as far as possible with a blocked tracheal cannula.

[Prolonged weaning during early neurological and neurosurgical rehabilitation : S2k guideline published by the Weaning Committee of the German Neurorehabilitation Society (DGNR)]. / Prolongiertes Weaning in der neurologisch-neurochirurgischen Frührehabilitation : S2k-Leitlinie herausgegeben von der Weaning-Kommission der Deutschen Gesellschaft für Neurorehabilitation e. V. (DGNR).

Prolonged weaning of patients with neurological or neurosurgery disorders is associated with specific characteristics, which are taken into account by the German Society for Neurorehabilitation (DGNR) in its own guideline. The current S2k guideline of the German Society for Pneumology and Respiratory Medicine is referred to explicitly with regard to definitions (e.g., weaning and weaning failure), weaning categories, pathophysiology of weaning failure, and general weaning strategies. In early neurological and neurosurgery rehabilitation, patients with central of respiratory regulation disturbances (e.g., cerebral stem lesions), swallowing disturbances (neurogenic dysphagia), neuromuscular problems (e.g., critical illness polyneuropathy, Guillain-Barre syndrome, paraplegia, Myasthenia gravis) and/or cognitive disturbances (e.g., disturbed consciousness and vigilance disorders, severe communication disorders), whose care during the weaning of ventilation requires, in addition to intensive medical competence, neurological or neurosurgical and neurorehabilitation expertise. In Germany, this competence is present in centers of early neurological and neurosurgery rehabilitation, as a hospital treatment. The guideline is based on a systematic search of guideline databases and MEDLINE. Consensus was established by means of a nominal group process and Delphi procedure moderated by the Association of the Scientific Medical Societies in Germany (AWMF). In the present guideline of the DGNR, the special structural and substantive characteristics of early neurological and neurosurgery rehabilitation and existing studies on weaning in early rehabilitation facilities are examined.Addressees of the guideline are neurologists, neurosurgeons, anesthesiologists, palliative physicians, speech therapists, intensive care staff, ergotherapists, physiotherapists, and neuropsychologists. In addition, this guideline is intended to provide information to specialists for physical medicine and rehabilitation (PMR), pneumologists, internists, respiratory therapists, the German Medical Service of Health Insurance Funds (MDK) and the German Association of Health Insurance Funds (MDS). The main goal of this guideline is to convey the current knowledge on the subject of "Prolonged weaning in early neurological and neurosurgery rehabilitation".

[Predictors of cognitive outcome in ventilated early rehabilitation patients]. / Prädiktoren des kognitiven Outcomes beatmeter Frührehabilitationspatienten.

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. CONCLUSION: 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.

[Oral feeding of long-term ventilated patients with a tracheotomy tube. Underestimated danger of dysphagia]. / Oralisierung langzeitbeatmeter Patienten mit Trachealkanüle. Unterschätzte Gefahr von Dysphagien.

BACKGROUND: In long-term mechanically ventilated patients, dysphagia is a common and potentially life-threatening complication, which can lead to aspiration and pneumonia. Nevertheless, many intensive care unit (ICU) patients are fed by mouth without evaluation of their deglutition capability. OBJECTIVE: The goal of this work was to evaluate the prevalence of aspiration due to swallowing disorders in long-term ventilated patients who were fed orally in the ICU while having a blocked tracheotomy tube. METHODS: In all, 43 patients participated-each underwent a fiberoptic investigation of deglutition on the day of admission to the rehabilitation clinic. RESULTS: A total of 65 % of the patients aspirated, 71 % of these silently. There were no associations between aspiration and any of the following: gender, indication for mechanical ventilation (underlying disease) or the duration of intubation and ventilation by tracheotomy tube. However, the association between aspiration and age was statistically significant (p = 0.041). Aspirating patients were older (arithmetic mean = 70 years, median = 74 years) than patients who did not aspirate (arithmetic mean = 66 years, median = 67 years). CONCLUSION: Intubation and add-on tracheotomies can lead to potentially life-threatening swallowing disorders that cause aspiration, independent of the underlying disease. Before feeding long-term mechanically ventilated patients by mouth, their ability to swallow needs to be investigated using fiberoptic endoscopic evaluation of swallowing (FEES) or a saliva dye test, if a cuff deflation and the use of a speaking valve are possible during spontaneous respiration.

[Confabulations--prior and recent theories of a mysterious syndrome]. / Konfabulationen--Alte und neue Theorien eines rätselhaften Phänomens.

Confabulations are no unitary syndrome, but comprise different forms of verbal statements with a varying aetiology. They can pertain to autobiographical events, semantic knowledge, the past, presence and future and are fabricated, distorted or misinterpreted memories or perceptions without conscious intent to deceive. Confabulations are caused by different mechanisms: on the one hand by disturbed memory processing (mainly by monitoring disturbances)--such as impairments in source monitoring or in the strategic retrieval of memories; on the other hand by perceptual disorders (such as neglect). Confabulations act as sense-makers in a current situation, as self-makers to keep one's identity in interaction with others and as world-makers to organize and legitimate actions.

[Effects of multisensory stimulation interventions in brain-damaged patients]. / Effekte multisensorischer Stimulationsverfahren bei hirngeschädigten Patienten.

Classical multisensory stimulation (MSS) programmes comprises modules for visual, acoustical, olfactorial and vestibularic stimulation. Therapeutic goal is a near-optimally structured and supporting environment adapted to the reduced abilities in perception and cognition of patients in a coma, with dementia, or with a learning disability. A critical review (based on the EMBASE and PubMed databases) shows that there is a shortage of studies as well as poor evidence of the effectiveness of multisensory stimulation approaches in general. A few studies show positive short-term effects concerning behavioural changes in patients in a coma, with dementia or with a learning disability but no evident long-term effects. Verifiable short-term effects, however, legitimate multisensory interventions in brain-damaged patients.