Rollnik J D, Adolphsen J, Bauer J, Bertram M, Brocke J, Dohmen C, Donauer E, Hartwich M, Heidler M D, Huge V, Klarmann S, Lorenzl S, Lück M, Mertl-Rötzer M, Mokrusch T, Nowak D A, Platz T, Riechmann L, Schlachetzki F, von Helden A, Wallesch C W, Zergiebel D, Pohl M
Neurologisches Zentrum mit Intensivmedizin, Stroke Unit und phasenübergreifender Rehabilitation, Akademisches Lehrkrankenhaus der Medizinischen Hochschule Hannover (MHH), Institut für neurorehabilitative Forschung (InFo), Assoziiertes Institut der Medizinischen Hochschule Hannover (MHH), BDH-Klinik Hessisch Oldendorf gGmbH, Greitstr. 18-28, 31840, Hessisch Oldendorf, Deutschland.
Berner Klinik Montana, Crans-Montana, Schweiz.
Nervenarzt. 2017 Jun;88(6):652-674. doi: 10.1007/s00115-017-0332-0.
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".
患有神经或神经外科疾病的患者长期撤机具有特定特征，德国神经康复学会（DGNR）在其自身指南中对此予以考虑。德国肺病和呼吸医学学会当前的S2k指南在定义（如撤机和撤机失败）、撤机类别、撤机失败的病理生理学以及一般撤机策略方面被明确提及。在早期神经和神经外科康复中，患有呼吸调节中枢紊乱（如脑干病变）、吞咽障碍（神经源性吞咽困难）、神经肌肉问题（如危重病性多发性神经病、格林 - 巴利综合征、截瘫、重症肌无力）和/或认知障碍（如意识障碍和警觉障碍、严重沟通障碍）的患者，其通气撤机期间的护理除了需要专业的医疗能力外，还需要神经或神经外科以及神经康复方面的专业知识。在德国，这种专业能力存在于早期神经和神经外科康复中心，作为一种医院治疗手段。该指南基于对指南数据库和MEDLINE的系统检索。通过德国科学医学协会（AWMF）主持的名义群体法和德尔菲法达成共识。在DGNR的本指南中，对早期神经和神经外科康复的特殊结构和实质特征以及早期康复机构中撤机的现有研究进行了审查。该指南的受众包括神经科医生、神经外科医生、麻醉医生、姑息治疗医生、言语治疗师、重症监护人员、职业治疗师、物理治疗师和神经心理学家。此外，本指南旨在为物理医学与康复（PMR）专家、肺病学家、内科医生、呼吸治疗师、德国医疗保险基金医疗服务机构（MDK）和德国医疗保险基金协会（MDS）提供信息。本指南的主要目标是传达关于“早期神经和神经外科康复中的长期撤机”这一主题的当前知识。
