Einhäupl Bernadette, Götze Danae, Reichl Stephanie, Willacker Lina, Pletz Romy, Kohlmann Thomas, Henning Esther, Schmeyers Lena, Straube Andreas, Süss Rebekka, Fleßa Steffen, Schmidt Simone, Rollnik Jens D, Müller Friedemann, Bartsch-de Jong Aukje, Blömeke Svenja, Hartl Jennifer, Vallejo Nuria, Liedert Daniel, Olander Thomas, Ziegler Volker, Weinhardt Renate, Schlachetzki Felix, Groß Tatjana, Hirmer Susanne, Dillbaner Lea, Kleinlein Lisa, Platz Thomas, Bender Andreas
Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany.
Neurorehabilitation Research Group, Faculty of Medicine, University of Greifswald, Greifswald, Germany.
Neurol Res Pract. 2025 May 19;7(1):35. doi: 10.1186/s42466-025-00384-1.
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.
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.
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.
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.
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.
在神经科早期康复（NER）期间，成功撤机和拔除气管套管（TC）的情况较为常见。然而，部分患者在NER结束时仍需保留TC并进行机械通气（MV），需要居家专业重症护理（HSICN）。关于这些患者的医学和人口统计学特征以及长期预后的数据有限。
一项针对德国五家NER医院的多中心回顾性观察研究收集了出院时仍需TC/MV的神经科患者的数据。该研究旨在评估NER出院时患者的健康状况，并确定出院后生存的预测因素。采用Kaplan-Meier估计法分析生存率；使用Cox回归分析出院后生存的其他预测因素。
在312例患者中，一年生存率为61.9%，约4年后降至38.1%。年龄较大、总体发病率较高以及出院时仍需MV与死亡可能性增加相关，而在NER停留时间较长与生存相关。
NER出院后需要HSICN的患者死亡率较高。识别生存预测因素可能有助于识别高危患者，从而可纳入NER出院的决策过程。出院后高死亡率值得对当前的院后护理模式进行评估。在HSICN环境中优化治疗护理可能有潜力降低死亡率和神经功能障碍，并提高这些神经严重受损患者的生活质量。
自2022年10月28日起，OptiNIV试验——神经科患者院后重症护理的回顾性研究已在德国临床试验注册中心（DRKS）进行回顾性注册，注册号为DRKS00030580。
