Risk factors for long-term invasive mechanical ventilation: a longitudinal study using German health claims data

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2024年1月27日

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Franziska C. Trudzinski,
Julia D. Michels-Zetsche,
Benjamin Neetz,
Jan Meis,
Michael Müller,
Axel Kempa,
Claus Neurohr,
Armin Schneider,
Felix J. F. Herth,
Joachim Szecsenyi,
Elena Biehler,
Thomas Fleischauer,
Michel Wensing,
Simone Britsch,
Janina Schubert-Haack,
Thomas Grobe,
Timm Frerk,
Felix Herth,
Gabriele Iberl,
Julia Dorothea Michels,
Beatrice Müller,
Michael Müller,
Benjamin Neetz,
Franziska Christina Trudzinski,
Martina Bentner,
Elena Biehler,
Thomas Fleischhhauer,
Johanna Forstner,
Gerhard Fuchs,
Nicola Litke,
Markus Qreini,
Selina von Schumann,
Noemi Sturm,
Joachim Szecsenyi,
Aline Weis,
Michel Wensing,
Timm Frerk,
Thomas Grobe,
Janina Schubert-Haack,
Anja Klingenberg,
Jan Meis,
Alex Kempa,
Biljana Joves,
Andreas Rheinhold,
Ahmed Ehab,
Claus Neurohr,
Alessandro Ghiani,
Nina Lutz,
Swenja Walcher,
Konstantinos Tsitouras,
Joanna Paderewska,
Selina Briese,
Armin Schneider,
Christoph Rauch,
Patrick Gehrig,
Joachim Sugg,
Susanne Hirschmann,
Simone Britsch,
Christa Straub,
Claude Jabbour,
Michael Hahn,
Jörg Krebs,
Peter-Tobias Graf,
Petra Denzer,
Uta Merle,
Mascha Fiedler,
Guido Hundt,
Jens Regula,
Miriane Bomeken,
Sebastian Stier,
Jens Müller,
Ute Oltmanns,
Tom Terboven,
Marcus Hennersdorf,
Neslihan Satir,
Mathias Borst,
Brigitte Mayer,
Wolfgang Reikow,
Markus Kredel,
Patrick Keppeler,
Konstantin Frey,
Holger Wolff,
Florian Seidlitz,
Stefanie Bientzle,
Boris Nohé,
Sebastian Allgäuer,
Alexej Schöpp,
Christoph Schlegel,
Imke Hübner,
Andrezj Kuzniar,
Helene Häberle,
Reimer Riessen,
Benjamin Schempf,
Ingo Rebenschütz,
Andreas Straub,
Marc Kollum,
Markus Winter,
Paul Hartveg,
Andreas Junginger,
Helmut Beck,
Mathias Vogel,
Ralf Völker,
Thomas Wiesmann

摘要

Background

Long-term invasive mechanical ventilation (IMV) is a major burden for those affected and causes high costs for the health care system. Early risk assessment is a prerequisite for the best possible support of high-risk patients during the weaning process. We aimed to identify risk factors for long-term IMV within 96 h (h) after the onset of IMV.

Methods

The analysis was based on data from one of Germany's largest statutory health insurance funds; patients who received IMV ≥ 96 h and were admitted in January 2015 at the earliest and discharged in December 2017 at the latest were analysed. OPS and ICD codes of IMV patients were considered, including the 365 days before intubation and 30 days after discharge. Long-term IMV was defined as evidence of invasive home mechanical ventilation (HMV), IMV ≥ 500 h, or readmission with (re)prolonged ventilation.

Results

In the analysis of 7758 hospitalisations, criteria for long-term IMV were met in 38.3% of cases, of which 13.9% had evidence of HMV, 73.1% received IMV ≥ 500 h and/or 40.3% were re-hospitalised with IMV. Several independent risk factors were identified (p < 0.005 each), including pre-diagnoses such as pneumothorax (OR 2.10), acute pancreatitis (OR 2.64), eating disorders (OR 1.99) or rheumatic mitral valve disease (OR 1.89). Among ICU admissions, previous dependence on an aspirator or respirator (OR 5.13), and previous tracheostomy (OR 2.17) were particularly important, while neurosurgery (OR 2.61), early tracheostomy (OR 3.97) and treatment for severe respiratory failure such as positioning treatment (OR 2.31) and extracorporeal lung support (OR 1.80) were relevant procedures in the first 96 h after intubation.

Conclusion

This comprehensive analysis of health claims has identified several risk factors for the risk of long-term ventilation. In addition to the known clinical risks, the information obtained may help to identify patients at risk at an early stage.

Trial registration The PRiVENT study was retrospectively registered at ClinicalTrials.gov (NCT05260853). Registered at March 2, 2022.