학술논문
Risk factors for long-term invasive mechanical ventilation: a longitudinal study using German health claims data
Document Type
Clinical report
Author
Trudzinski, Franziska C.; Michels-Zetsche, Julia D.; Neetz, Benjamin; Meis, Jan; Müller, Michael; Kempa, Axel; Neurohr, Claus; Schneider, Armin; Herth, Felix J. F.; Szecsenyi, Joachim; Biehler, Elena; Fleischauer, Thomas; Wensing, Michel; Britsch, Simone; Schubert-Haack, Janina; Grobe, Thomas; Frerk, Timm; Herth, Felix; Iberl, Gabriele; Michels, Julia Dorothea; Müller, Beatrice; Trudzinski, Franziska Christina; Bentner, Martina; Fleischhhauer, Thomas; Forstner, Johanna; Fuchs, Gerhard; Litke, Nicola; Qreini, Markus; von Schumann, Selina; Sturm, Noemi; Weis, Aline; Klingenberg, Anja; Kempa, Alex; Joves, Biljana; Rheinhold, Andreas; Ehab, Ahmed; Ghiani, Alessandro; Lutz, Nina; Walcher, Swenja; Tsitouras, Konstantinos; Paderewska, Joanna; Briese, Selina; Rauch, Christoph; Gehrig, Patrick; Sugg, Joachim; Hirschmann, Susanne; Straub, Christa; Jabbour, Claude; Hahn, Michael; Krebs, Jörg; Graf, Peter-Tobias; Denzer, Petra; Merle, Uta; Fiedler, Mascha; Hundt, Guido; Regula, Jens; Bomeken, Miriane; Stier, Sebastian; Müller, Jens; Oltmanns, Ute; Terboven, Tom; Hennersdorf, Marcus; Satir, Neslihan; Borst, Mathias; Mayer, Brigitte; Reikow, Wolfgang; Kredel, Markus; Keppeler, Patrick; Frey, Konstantin; Wolff, Holger; Seidlitz, Florian; Bientzle, Stefanie; Nohé, Boris; Allgäuer, Sebastian; Schöpp, Alexej; Schlegel, Christoph; Hübner, Imke; Kuzniar, Andrezj; Häberle, Helene; Riessen, Reimer; Schempf, Benjamin; Rebenschütz, Ingo; Straub, Andreas; Kollum, Marc; Winter, Markus; Hartveg, Paul; Junginger, Andreas; Beck, Helmut; Vogel, Mathias; Völker, Ralf; Wiesmann, Thomas
Source
Respiratory Research. January 27, 2024, Vol. 25 Issue 1
Subject
Language
English
ISSN
1465-9921
Abstract
Author(s): Franziska C. Trudzinski[sup.1], Julia D. Michels-Zetsche[sup.1], Benjamin Neetz[sup.1], Jan Meis[sup.2], Michael Müller[sup.1], Axel Kempa[sup.3], Claus Neurohr[sup.4], Armin Schneider[sup.5], Felix J. F. Herth[sup.1], Joachim Szecsenyi[sup.6,7], Elena Biehler[sup.6], Thomas Fleischauer[sup.6], Michel [...]
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 [greater than or equal to] 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 [greater than or equal to] 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 [greater than or equal to] 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. Keywords: Long-term invasive mechanical ventilation, Invasive home mechanical ventilation, Weaning, Weaning failure, Prolonged weaning, Prognostic factors, Predictive model
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 [greater than or equal to] 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 [greater than or equal to] 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 [greater than or equal to] 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. Keywords: Long-term invasive mechanical ventilation, Invasive home mechanical ventilation, Weaning, Weaning failure, Prolonged weaning, Prognostic factors, Predictive model