Risk factors for long-term invasive mechanical ventilation: a longitudinal study using German health claims data
Authors: 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 ,   The PRiVENT-study group, Herth Felix , Iberl Gabriele , Michels Julia Dorothea , Müller Beatrice , Müller Michael , Neetz Benjamin , Trudzinski Franziska Christina , Bentner Martina , Biehler Elena , Fleischhhauer Thomas , Forstner Johanna , Fuchs Gerhard , Litke Nicola , Qreini Markus , von Schumann Selina , Sturm Noemi , Szecsenyi Joachim , Weis Aline , Wensing Michel , Frerk Timm , Grobe Thomas , Schubert-Haack Janina , Klingenberg Anja , Meis Jan , Kempa Alex , Joves Biljana , Rheinhold Andreas , Ehab Ahmed , Neurohr Claus , Ghiani Alessandro , Lutz Nina , Walcher Swenja , Tsitouras Konstantinos , Paderewska Joanna , Briese Selina , Schneider Armin , Rauch Christoph , Gehrig Patrick , Sugg Joachim , Hirschmann Susanne , Britsch Simone , Straub Christa , Jabbour Claude , Hahn Michael , Krebs Jörg , Graf Peter-Tobias , Denzer Petra , Merle Uta , Fiedler Mascha , Hundt Guido , Regula Jens , Bomeken Miriane , Stier Sebastian , Müller Jens , Oltmanns Ute , Terboven Tom , Hennersdorf Marcus , Satir Neslihan , Borst Mathias , Mayer Brigitte , Reikow Wolfgang , Kredel Markus , Keppeler Patrick , Frey Konstantin , Wolff Holger , Seidlitz Florian , Bientzle Stefanie , Nohé Boris , Allgäuer Sebastian , Schöpp Alexej , Schlegel Christoph , Hübner Imke , Kuzniar Andrezj , Häberle Helene , Riessen Reimer , Schempf Benjamin , Rebenschütz Ingo , Straub Andreas , Kollum Marc , Winter Markus , Hartveg Paul , Junginger Andreas , Beck Helmut , Vogel Mathias , Völker Ralf , Wiesmann Thomas 
Published: January 2024

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.