Karagiannidis Christian, Strassmann Stephan, Callegari Jens, Kochanek Matthias, Janssens Uwe, Windisch Wolfram
Lungenklinik Köln-Merheim, ARDS- und ECMO-Zentrum, Kliniken der Stadt Köln gGmbH, Köln, Universität Witten/Herdecke, Fakultät für Gesundheit/Department für Humanmedizin.
Klinik I für Innere Medizin (Hämatologie und Onkologie), Universitätsklinikum Köln, Köln.
Dtsch Med Wochenschr. 2019 May;144(9):e58-e63. doi: 10.1055/a-0758-4512. Epub 2018 Nov 21.
Home mechanical ventilation is dramatically evolving in Germany. Patients with non-invasive and invasive ventilation are increasingly treated at home. In-hospital treatment of these patients is also necessary either for control visits or the management of acute medical problems. However, the development of in-hospital patient care, morbidity and mortality of these patients is unknown.
All patients with long-term dependence on mechanical ventilation for more than three months requiring hospitalisation between 2006 and 2016 were analysed (data obtained from the Federal Statistical Office of Germany).
There was an exponential increase in the number of in-patients with long-term dependence of mechanical ventilation. While 24 845 patients were treated in-hospital in 2006, 86 117 patients were treated in 2016. Correspondingly, mortality decreased from 13.2 % (2006) to 5.7 % (2016). In addition, in 2016 47 % of all patients were treated on the intensive care or high dependency care unit. Overall, patients had been severely ill, as there were plenty of medical and neurological co-morbidities. The most common diagnosis was COPD with 58 % of all cases, followed by several cardiology diagnosis. A high number of patients had an impairment of renal function (24 %), in part requiring dialysis.
The rapid development of home mechanical ventilation substantially impacts on the development of the hospital landscape in Germany. The exponential increase of these care-intensive patients is challenging for the health care system and requires a discussion about its limits.
家庭机械通气在德国正经历巨大变革。无创和有创通气患者越来越多地在家中接受治疗。这些患者的住院治疗对于控制访视或处理急性医疗问题也是必要的。然而，这些患者的住院患者护理发展情况、发病率和死亡率尚不清楚。
对2006年至2016年间所有长期依赖机械通气超过三个月且需要住院治疗的患者进行分析（数据来自德国联邦统计局）。
长期依赖机械通气的住院患者数量呈指数增长。2006年有24845名患者接受住院治疗，2016年这一数字为86117名。相应地，死亡率从2006年的13.2%降至2016年的5.7%。此外，2016年所有患者中有47%在重症监护病房或高依赖护理病房接受治疗。总体而言，患者病情严重，存在大量医学和神经方面的合并症。最常见的诊断是慢性阻塞性肺疾病（COPD），占所有病例的58%，其次是几种心脏病诊断。大量患者存在肾功能损害（24%），部分患者需要透析。
家庭机械通气的快速发展对德国医院格局的发展产生了重大影响。这些护理密集型患者数量的指数增长对医疗保健系统构成挑战，需要对其局限性进行讨论。
