Cooperation creates potential


DEUTSCHEFACHPFLEGE is an association of three care groups that jointly cover the entire spectrum of care throughout Germany. By working together, we are able to provide individual, tailored care close to home for all clients.
Find out more about us

Our employees are qualified healthcare, nursing and geriatric nurses with additional qualifications such as intensive and anaesthetic care, respiratory therapy, wound management, pain management and palliative care. They are also qualified to work in intensive care and respiratory care and always focus on the individual therapy goal in order to create the highest possible quality of life for the client. Our aim is to enable those in need of care and their relatives to lead as normal a life as possible, whether this only requires hourly care or 24-hour care.

Our care density continues to increase throughout Germany. A major step forward for most people who need support and care is being able to stay in their familiar surroundings. Clients are provided with needs-based care in their own home or at least in the immediate vicinity and have a variety of different forms of support to choose from.

Flexibility is a major strength of our network. The range of services is „tailored“ to the individual situation of infants, small children, young people, middle-aged clients or senior citizens. If the state of health changes, the care assignment can be adapted quickly and easily.

Worth knowing

The outpatient care services under the umbrella of DEUTSCHENFACHPFLEGE care for over 9,300 clients in various forms of care. 1.970 are intensive care clients and 7,290 are elderly and nursing care clients. They are cared for by over 12,000 employees.

Apallic syndrome – vegetative state

Waking coma is one of the most common clinical pictures in out-of-hospital intensive care. According to statistics, at least 10,000 people in Germany suffer severe brain injuries and fall into a vegetative state every year as a result of car accidents, sports, falls, strokes, traumatic events or illnesses. It is impossible to predict when and whether those affected will regain consciousness. The vegetative state can last for several weeks, months and, in the worst case, until the end of life. In this extremely difficult life situation, relatives are dependent on competent help.

DEUTSCHEFACHPFLEGE offers relatives every conceivable support to provide optimum care for people in a vegetative state:

Shared apartments with respiratory care and intensive care services
Individual care in the home environment
Inpatient care homes

Definition of

Apallic syndrome (colloquially known as vegetative state) is caused by severe craniocerebral trauma affecting the cerebrum or parts of it. This can lead to a functional failure of the entire cerebral function. In apallic syndrome, the functions of the diencephalon, brain stem and spinal cord remain intact. As a result, those affected appear awake, but in all likelihood have no consciousness and only very limited possibilities for communication. The resulting neurological damage to the cerebral cortex is one of the most severe forms of brain damage.

Despite their condition, coma patients have regular periods of sleep with their eyes closed, just like healthy people. However, their day and night rhythms are disturbed. The clients do not have the ability to make contact with the environment or to consciously perceive their surroundings or react to external stimuli. Due to the loss of awareness of their own person, they also have no control over their bowel and bladder activity. There is complete incontinence.
Waking coma misdiagnoses

According to studies, up to 40% of vegetative state diagnoses prove to be incorrect. In order to reduce the number of misdiagnoses, the Multi-Society Task Force on PVS defined diagnostic criteria for vegetative state in 1994. These characteristics help to make a clear diagnosis of apallic syndrome. This method avoids the misdiagnosis of unnoticed patients who are almost fully conscious.
The following vegetative state criteria are used for assessment

Loss of the ability to interact with the environment
Loss of awareness of one’s own person
Loss of the normal sleep-wake rhythm
Loss of speech comprehension and speech production
Loss of the ability to react to external stimuli in a targeted manner
Loss of control over bowel and bladder activity (total incontinence)
Loss of autonomic reflexes


Awake coma clients live in their own world. They fall into an apallic state in which their eyes are open and they stare into space. Due to their loss of mobility, they are unable to communicate. They can neither eat nor drink and therefore have to be artificially fed and sometimes ventilated. In most cases, artificial respiration can be discontinued after a few weeks.

The apallic patient is in a state between deep unconsciousness (coma) and unconscious wakefulness. It is possible that reactions and movements are triggered by brain activity. Sometimes only with primitive reflexes to external stimuli. Via the intact vegetative nervous system, it is possible for the bowel and bladder to empty involuntarily via incontinence.

Although the autonomic nervous system is not affected, disorders can occur after a few weeks in the apallic state. Symptoms include sudden high blood pressure, palpitations, profuse sweating and even muscle contractions. In most cases, this has no negative impact, but the symptoms must be treated with medication to stabilize the condition.

It is possible that bodily functions will gradually recover and artificial respiration will be stopped. The first visible signs are unsteady eye movements and uncontrolled facial expressions. Apallic syndrome does not always have a positive outcome. If bilateral pyramidal tracts or the brain stem are affected, tetraspasticity (paralysis of all four extremities) can develop.

Apallic syndrome can have various causes.

Car accidents, accidents with massive brain damage, falls from a great height or illnesses that affect the brain.
Hypoglycemic shock can occur as a result of prolonged hypoglycemia. This results in a massive drop in blood pressure and reduced blood flow to the organs. The diabetic falls into a coma. This can be followed by an apallic state.
Parkinson’s disease is a disease of the nervous system. It affects a region of the brain, whereby the nervous system is also affected.
As a result of a lack of oxygen due to cardiovascular arrest or other serious acute illnesses, the client can fall into a vegetative state.
This can be triggered by a stroke due to damage to brain tissue or complete blockage of brain vessels. This results in a reduced oxygen supply to the brain.
Benign or rapidly growing malignant tumors can destroy the brain cells.
Meningitis: This is an inflammation of the membranes of the brain and spinal cord of the central nervous system (CNS). Caused by viruses, bacteria or other microorganisms.
Damage to the thalamus: This is the connection to the entire cerebral cortex and is called „the gateway to consciousness“. Or if the neuron network (formatio reticularis) in the brain stem is also affected. Injuries to the cortex are actually permanent. It has been known to partially recover despite a poor prognosis.

Therapy and treatment

The first treatment measures begin a few hours after the onset of severe brain damage. Clients are initially mainly treated in the intensive care unit of a clinic. Acute treatment is the top priority in order to maintain vital functions. Comatose clients are given artificial respiration. Either via intubation or after a tracheotomy with a tracheostomy tube. Nutrition is provided via an abdominal tube.
Further supportive measures include instrument-based diagnostic procedures.

Magnetic resonance imaging (MRI) is used to examine the metabolic processes in the brain and visualize the tissue parts.
The electroencephalogram (EEG) is used to measure brain activity.
Somatically evoked potentials (SEP) are used to test the conductivity and thus the functionality of nerve pathways.

With these procedures and further examinations on a neurological basis and a detailed overall examination, a cautious prognosis with adapted therapies can be initiated at a very early stage. This concludes the acute care, phase A, in the clinic with life-sustaining measures.

Once it has been ensured that the patient’s life is no longer in danger, stage B early rehabilitation follows. The aim is to bring the apallic patient back to life and prevent further damage.

Interdisciplinary cooperation with doctors, physiotherapists, speech therapists, music therapists and nursing staff ensures that each individual is treated individually. The condition of the apallic client is taken into account. Passive gymnastic exercises are carried out in the early stages. These measures prevent joints from stiffening and muscles from cramping and shortening. The movements also ventilate the lungs and can ward off pneumonia. This is because it is necessary for the oxygen in the air to diffuse through the inner surface of the lungs, to be transported to the tissues and cells with the help of the blood and for the carbon dioxide from the cells and tissues to be transported to the lungs via the blood and finally exhaled.

Stimulating stimuli are extremely important for awake coma patients in order to reach deep consciousness. Part of the therapy is basal and tactile stimulation through stroking, touching various fabrics, soft toys and light massages. The skin is the largest sensory organ and can transmit tactile stimuli to the brain. Music and language are also important. Stories from earlier times can penetrate deep into the consciousness and possibly accelerate the awakening phase. If the condition allows and the client is breathing independently, the coma client can be dressed and placed in a wheelchair after the morning wash and thus participate in life.