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CC BY-NC-ND 4.0 · Dtsch Med Wochenschr 2019; 144(13): e80-e86
DOI: 10.1055/a-0826-2296
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Pneumologische Frührehabilitation nach Langzeitbeatmung

Early pulmonary rehabilitation after long term mechanical ventilation
Dominic Dellweg
1   Fachkrankenhaus Kloster Grafschaft GmbH, Abteilung Pneumologie I
,
Karsten Siemon
1   Fachkrankenhaus Kloster Grafschaft GmbH, Abteilung Pneumologie I
,
Ekkehard Höhn
1   Fachkrankenhaus Kloster Grafschaft GmbH, Abteilung Pneumologie I
,
Thomas Barchfeld
2   Klinikum Westfalen, Knappschaftskrankenhaus Dortmund; Medizinische Klinik 2
,
Dieter Köhler
1   Fachkrankenhaus Kloster Grafschaft GmbH, Abteilung Pneumologie I
› Author Affiliations
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Publication History

Publication Date:
28 June 2019 (online)

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Zusammenfassung

Einleitung Unter Frührehabilitation versteht man eine frühzeitig bei- oder nach akuter Erkrankung einsetzende, rehabilitationsmedizinische Behandlung die im § 39SGB V verankert ist. Ziel dieser Untersuchung ist es, die Ergebnisqualität der pneumologischen Frührehabilitation zu untersuchen und darzustellen.

Methoden Prospektive Erhebung von funktionellen Parametern, Beatmungsstatus und Entlass-Disposition in einer spezialisierten Abteilung für pneumologische Frührehabilitation über den Zeitraum von einem Jahr.

Ergebnisse Von den 190 Patienten waren 179 (94,2 %) zuvor invasiv beatmet. Während einer Behandlungsdauer von 39 ± 17 Tagen stieg der FAM-Index von 84,4 ± 19,8 auf 118,5 ± 23,3 (Ci 30,9 – 37,3, Cohen’s d 1,58; p < 0,001), der Barthel-Index von 30,5 ± 13,8 auf 58,3 ± 16,2 (Ci 25,4 – 33,8, Cohen’s d 1,4; p < 0,001) und die Wegstrecke von 12,9 ± 40,1 m auf 131,4 ± 85,2 m (Ci 105,6 – 131,4 m, Cohen’s d 1,78; p < 0,001). Die Patienten wurden weniger häufig in eine weitere Anschlussheilbehandlung verlegt, wenn sie beatmet waren.

Diskussion Patienten in der pneumologischen Frührehabilitation sind bei Aufnahme schwer kompromittiert, es lässt sich aber eine sehr gute Ergebnisqualität erzielen, die unabhängig davon zu sein scheint, ob der Patient eigenständig atmet oder mittels nicht-invasiver oder invasiver Beatmung versorgt wird. Die weitere Disposition dieser Patienten ist vor allem dann schwierig, wenn eine Beatmung vorliegt.

Abstract

Background The term early rehabilitation is defined as a rehabilitation that begins in the early phase after acute illness and is statutory positioned in § 39SGB V. Aim of this investigation is to describe the quality of outcome of pulmonary early rehabilitation.

Method Prospective census of functional parameters, status of ventilation and discharge-disposition in a specialized unit for early pulmonary rehabilitation over a period of one year.

Results Out of 190 patients 179 (94.2 %) were previously invasively ventilated. During the treatment period of 39 ± 17 days, FAM-Index increased from 84.4 ± 19.8 to 118.5 ± 23.3 (Ci 30.9 – 37.3, Cohen’d 1.58; p < 0.001), Barthel-Index from 30.5 ± 13.8 to 58.3 ± 16.2 (Ci 25.4 – 33.8, Cohen’s d 1.4; p < 0.001) six minute walking distance from 12.9 ± 40.1 m to 131.4 ± 85.2 m (Ci 105.6 – 131.4 m, Cohn’s d 1.78; p < 0.001). Patients were less likely to be receive further post-discharge rehabilitation if they were ventilated.

Conclusion Patients admitted to the early pulmonary rehabilitation unit were severely compromised, however quality of outcome was favourable and independent of the breathing status (spontaneously breathing vs. non-invasive ventilation or invasive ventilation). Finding discharge dispositions appeared to be more difficult if patients were ventilated.

Schlüsselwörter

pneumologische Frührehabilitation - Beatmung - Langzeitbeatmung - Wegstrecke - Entlass-Disposition

Key words

pulmonary early rehabilitation - ventilation - long term ventilation - walking distance - discharge disposition
 

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