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Background <p>Weaning from mechanical ventilation (MV) and tracheal cannula (TC) during neurological early rehabilitation (NER) is mostly successful. However, some patients leave NER with TC/MV, requiring home-based specialized intensive care nursing (HSICN). Data on medical and demographic characteristics and long-term outcomes of these patients are limited.</p> Methods <p>A multicentric retrospective observational study across five German NER hospitals collected data from neurological patients with TC/MV at discharge. The study aimed to assess patients’ health status at NER discharge, and to identify predictors of post-discharge survival. Survival rates were analyzed using Kaplan-Meier estimates; further predictors of survival post-discharge were analyzed using Cox regression.</p> Results <p>Among 312 patients, the one-year survival rate was 61.9%, decreasing to 38.1% after approximately 4 years. Older age, higher overall morbidity and discharge with MV were associated with an increased likelihood of death, while a longer stay in NER correlated with survival.</p> Conclusions <p>Patients requiring HSICN after discharge from NER have a high mortality rate. Identifying survival predictors may help to identify patients at risk, and thus could be integrated into the decision-making process for NER discharge. The high mortality post-discharge warrants an evaluation of the current post-hospital care model. Optimizing therapeutic care in the HSICN setting may have the potential to reduce mortality and neuro-disability, and enhance the quality of life in these neurologically severely affected patients.</p> Trial registration <p>The trial <i>OptiNIV - Retrospective study of post-hospital intensive care in neurological patients</i> has been retrospectively registered in the German Clinical Trials Register (DRKS) since 28.10.2022 with the ID DRKS00030580.</p>

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Long-term outcomes of community-based intensive care treatment following neurological early rehabilitation– results of a multicentric German study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年5月19日

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  • Bernadette Einhäupl,
  • Danae Götze,
  • Stephanie Reichl,
  • Lina Willacker,
  • Romy Pletz,
  • Thomas Kohlmann,
  • Esther Henning,
  • Lena Schmeyers,
  • Andreas Straube,
  • Rebekka Süss,
  • Steffen Fleßa,
  • Simone Schmidt,
  • Jens D. Rollnik,
  • Friedemann Müller,
  • Aukje Bartsch-de Jong,
  • Svenja Blömeke,
  • Jennifer Hartl,
  • Nuria Vallejo,
  • Daniel Liedert,
  • Thomas Olander,
  • Volker Ziegler,
  • Renate Weinhardt,
  • Felix Schlachetzki,
  • Tatjana Groß,
  • Susanne Hirmer,
  • Lea Dillbaner,
  • Lisa Kleinlein,
  • Thomas Platz,
  • Andreas Bender

摘要

Background

Weaning from mechanical ventilation (MV) and tracheal cannula (TC) during neurological early rehabilitation (NER) is mostly successful. However, some patients leave NER with TC/MV, requiring home-based specialized intensive care nursing (HSICN). Data on medical and demographic characteristics and long-term outcomes of these patients are limited.

Methods

A multicentric retrospective observational study across five German NER hospitals collected data from neurological patients with TC/MV at discharge. The study aimed to assess patients’ health status at NER discharge, and to identify predictors of post-discharge survival. Survival rates were analyzed using Kaplan-Meier estimates; further predictors of survival post-discharge were analyzed using Cox regression.

Results

Among 312 patients, the one-year survival rate was 61.9%, decreasing to 38.1% after approximately 4 years. Older age, higher overall morbidity and discharge with MV were associated with an increased likelihood of death, while a longer stay in NER correlated with survival.

Conclusions

Patients requiring HSICN after discharge from NER have a high mortality rate. Identifying survival predictors may help to identify patients at risk, and thus could be integrated into the decision-making process for NER discharge. The high mortality post-discharge warrants an evaluation of the current post-hospital care model. Optimizing therapeutic care in the HSICN setting may have the potential to reduce mortality and neuro-disability, and enhance the quality of life in these neurologically severely affected patients.

Trial registration

The trial OptiNIV - Retrospective study of post-hospital intensive care in neurological patients has been retrospectively registered in the German Clinical Trials Register (DRKS) since 28.10.2022 with the ID DRKS00030580.