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
Department of Pneumology and Critical Care, Thoraxklinik Heidelberg gGmbH, Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Heidelberg, Germany.
Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany.
Respir Res. 2024 Jan 27;25(1):60. doi: 10.1186/s12931-024-02693-6.
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.
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.
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.
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.
长期有创机械通气（IMV）对患者而言是一项重大负担，也给医疗保健系统带来高昂成本。早期风险评估是在撤机过程中为高风险患者提供最佳支持的前提条件。我们旨在确定IMV开始后96小时内长期IMV的风险因素。
分析基于德国最大的法定健康保险基金之一的数据；对最早于2015年1月入院、最晚于2017年12月出院且接受IMV≥96小时的患者进行分析。考虑了IMV患者的手术操作编码（OPS）和国际疾病分类编码（ICD），包括插管前365天和出院后30天。长期IMV定义为有创家庭机械通气（HMV）证据、IMV≥500小时或再次入院并伴有（再次）延长通气。
在对7758次住院治疗的分析中，38.3%的病例符合长期IMV标准，其中13.9%有HMV证据，73.1%接受IMV≥500小时和/或40.3%因IMV再次住院。确定了几个独立风险因素（每个p<0.005），包括气胸（OR 2.10）、急性胰腺炎（OR 2.64）、饮食失调（OR 1.99）或风湿性二尖瓣疾病（OR 1.89）等前期诊断。在入住重症监护病房的患者中，先前依赖吸引器或呼吸器（OR 5.13）和先前气管切开术（OR 2.17）尤为重要，而神经外科手术（OR 2.61）、早期气管切开术（OR 3.97）以及严重呼吸衰竭的治疗，如体位治疗（OR 2.31）和体外肺支持（OR 1.80）是插管后最初96小时内的相关操作。
这项对健康索赔的综合分析确定了长期通气风险的几个风险因素。除了已知的临床风险外，所获得的信息可能有助于早期识别有风险的患者。试验注册PRiVENT研究在ClinicalTrials.gov进行了回顾性注册（NCT05260853）。于2022年3月2日注册。
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