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Trudzinski FC, Michels-Zetsche JD, Neetz B, Meis J, Müller M, Kempa A, Neurohr C, Schneider A, Herth FJF, Szecsenyi J, Biehler E, Fleischauer T, Wensing M, Britsch S, Schubert-Haack J, Grobe T, Frerk T. Risk factors for long-term invasive mechanical ventilation: a longitudinal study using German health claims data. Respir Res 2024; 25:60. [PMID: 38281006 PMCID: PMC10821552 DOI: 10.1186/s12931-024-02693-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/18/2024] [Indexed: 01/29/2024] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Franziska C Trudzinski
- 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.
| | - Julia D Michels-Zetsche
- 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
| | - Benjamin Neetz
- 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
| | - Jan Meis
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Michael Müller
- 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
| | - Axel Kempa
- Department of Pneumology and Critical Care, SLK-Klinik Löwenstein, Löwenstein, Germany
| | - Claus Neurohr
- Department of Pneumology and Respiratory Medicine, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen, Germany
| | - Armin Schneider
- Department of Anesthesia and Intensive Care Medicine Waldburg-Zeil Kliniken, Wangen Im Allgäu, Germany
| | - Felix J F Herth
- 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
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
- aQua Institute for Applied Quality Improvement and Research in Health Care, Göttingen, Germany
| | - Elena Biehler
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Fleischauer
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Simone Britsch
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Mannheim, Germany
- European Center for Angioscience (ECAS) and German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Janina Schubert-Haack
- aQua Institute for Applied Quality Improvement and Research in Health Care, Göttingen, Germany
| | - Thomas Grobe
- aQua Institute for Applied Quality Improvement and Research in Health Care, Göttingen, Germany
| | - Timm Frerk
- aQua Institute for Applied Quality Improvement and Research in Health Care, Göttingen, Germany
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Gonzalez F, Starka R, Ducros L, Bisbal M, Chow-Chine L, Servan L, de Guibert JM, Pastene B, Faucher M, Sannini A, Leone M, Mokart D. Critically ill metastatic cancer patients returning home after unplanned ICU stay: an observational, multicentre retrospective study. Ann Intensive Care 2023; 13:73. [PMID: 37605072 PMCID: PMC10441975 DOI: 10.1186/s13613-023-01170-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/03/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Data about critically ill metastatic cancer patients functional outcome after unplanned admission to the ICU are scarce. The aim of this study was to assess factors associated with 90-day return home and 1-year survival in this population. STUDY DESIGN AND METHODS A multicenter retrospective study included all consecutive metastatic cancer patients admitted to the ICU for unplanned reason between 2017 and 2020. RESULTS Among 253 included metastatic cancer patients, mainly with lung cancer, 94 patients (37.2%) could return home on day 90. One-year survival rate was 28.5%. Performance status 0 or 1 (OR, 2.18; 95% CI 1.21-3.93; P = 0.010), no malnutrition (OR, 2.90; 95% CI 1.61-5.24; P < 0.001), female gender (OR, 2.39; 95% CI 1.33-4.29; P = 0.004), recent chemotherapy (OR, 2.62; 95% CI 1.40-4.90; P = 0.003), SOFA score ≤ 5 on admission (OR, 2.62; 95% CI 1.41-4.90; P = 0.002) were significantly predictive for 90-day return home. Malnutrition (HR, 1.66; 95% CI 1.18-2.22; P = 0.003), acute respiratory failure (ARF) as reason for admission (HR, 1.40; 95% CI 1.10-1.95; P = 0.043), SAPS II on admission (HR, 1.03; 95% CI 1.02-1.05; P < 0.001) and decisions to forgo life-sustaining therapies (DFLST) (HR, 2.80; 95% CI 2.04-3.84; P < 0.001) were independently associated with 1-year mortality. CONCLUSIONS More than one out of three metastatic cancer patients could return home within 3 months after an unplanned admission to the ICU. Previous performance and nutritional status, ongoing specific treatment and low severity of the acute illness were found to be predictive for return home. Such encouraging findings should help change the dismal perception of critically ill metastatic cancer patients.
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Affiliation(s)
- Frédéric Gonzalez
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 13009 Marseille Cedex 09, France
| | - Rémi Starka
- Polyvalent Intensive Care Unit, Sainte Musse Hospital, Toulon, France
| | - Laurent Ducros
- Polyvalent Intensive Care Unit, Sainte Musse Hospital, Toulon, France
| | - Magali Bisbal
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 13009 Marseille Cedex 09, France
| | - Laurent Chow-Chine
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 13009 Marseille Cedex 09, France
| | - Luca Servan
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 13009 Marseille Cedex 09, France
| | - Jean-Manuel de Guibert
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 13009 Marseille Cedex 09, France
| | - Bruno Pastene
- Department of Anesthesiology and Intensive Care Unit, Nord Hospital, Assistance Publique Hôpitaux Universitaire de Marseille, Aix Marseille University, Marseille, France
| | - Marion Faucher
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 13009 Marseille Cedex 09, France
| | - Antoine Sannini
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 13009 Marseille Cedex 09, France
| | - Marc Leone
- Department of Anesthesiology and Intensive Care Unit, Nord Hospital, Assistance Publique Hôpitaux Universitaire de Marseille, Aix Marseille University, Marseille, France
| | - Djamel Mokart
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 13009 Marseille Cedex 09, France
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