Fachübergreifende Frührehabilitation nach Sepsis – Eine retrospektive Analyse *

Zusammenfassung

Theoretischer Hintergrund Nach überlebter Sepsis besteht bei vielen Patienten ein erheblicher Rehabilitationsbedarf. Die fachübergreifende Frührehabilitation ist ein Konzept zur frühen rehabilitativen Versorgung noch im Akutkrankenhaus, direkt anschließend an die Frühmobilisation auf der Intensivstation. Sie ist oft grundlegend für die Wiederherstellung der Rehabilitationsfähigkeit im Sinne der weiterführenden Rehabilitation.

Methode Diese retrospektive Analyse untersucht eine Patientenstichprobe, die nach überlebter Sepsis eine fachübergreifende Frührehabilitation erhielt. Als Parameter dienten die basalen Funktionen Mobilität und Selbsthilfefähigkeit sowie Hilfsmittelbedarf und Verlegungsumgebung.

Ergebnisse Die Veränderungen der Mobilität und Selbsthilfefähigkeit vor und nach der Frührehabilitation sind hoch signifikant (je p<0,001), die Effektstärken sehr stark (d=1,3 und 1,4). 92% der Patienten wurden differenziert mit Hilfsmitteln versorgt. Ein Großteil der Patienten (42,4%) erhielt eine fortführende stationäre Rehabilitation.

Diskussion Die dargestellten Daten belegen die enormen Funktionsgewinne, die Sepsis-Patienten im Rahmen einer fachübergreifenden Frührehabilitation erzielen können.

Abstract

Background Surviving sepsis may have consequences of high impact for the patients’ further life regarding functioning in mobility and activities of daily living, among other fields. Patients consecutively have a great need of rehabilitation interventions beginning with early mobilization in the Intensive Care Unit ICU. Acute medical rehabilitation is a concept of early rehabilitation still in the acute care hospital, normally beginning after a direct transferal from the ICU. Its aim is to improve the patients’ functioning in mobility and activities of daily living (ADL) to enable further post-acute rehabilitation interventions.

Methods In this retrospective analysis a sample of patients who received acute medical rehabilitation after surviving a sepsis or severe sepsis was followed. The study targeted the question if basic functions of mobility and ADL could be improved by acute medical rehabilitation. Furthermore, the need for aid supply was evaluated, as well as the type of discharge or transferal after acute care.

Results The increase of mobility and ADL capability before and after acute medical rehabilitation was highly significant (p<0.001 each) and showed very large effect sizes (d=1.3, 1.4 respectively). Aid supply was organized for 92% of patients. A majority of patients could receive consecutive post-acute rehabilitation after re-gaining function.

Discussion The data shows the enormous gain in functioning that can be reached with an acute medical rehabilitation intervention after ICU treatment of sepsis.

Schlüsselwörter

fachübergreifende Frührehabilitation - Frühmobilisation - Sepsis - Post intensive care Syndrom

Key words

acute medical rehabilitation - acute care rehabilitation - sepsis - post intensive care syndrome - ICU acquired weakness

^☆ Teile dieser Arbeit wurden auf dem Leopoldina-Symposium 2017 mit dem Titel „The Evolution of Intensive Care Medicine: From Recumbency to Fully Functioning in Everyday Life – Preservation of Cognition and Mobility“ am 24.-25. Februar 2017 in Berlin als Posterpräsentation vorgestellt.

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