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

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 (2025): Long-term outcomes of community-based intensive care treatment following neurological early rehabilitation– results of a multicentric German study. Neurological Research and Practice, 7: 35. ISSN 2524-3489

Abstract

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.

• Dokumententyp: Artikel (Klinikum der LMU)
• Organisationseinheit (Fakultäten): 07 Medizin > Klinikum der LMU München > Neurologische Klinik und Poliklinik mit Friedrich-Baur-Institut
• DFG-Fachsystematik der Wissenschaftsbereiche: Lebenswissenschaften
• DFG: Gefördert durch die Deutsche Forschungsgemeinschaft (DFG) - 491502892