In Baden-Württemberg, a two-year intervention program started on 1 July 2021 to identify at-risk patients who could be candidates for ventilator weaning after long-term ventilation due to intubation. Franziska Trudzinski, an expert in pneumology and intensive care medicine at the Thorax Clinic in Heidelberg, is responsible for the project. She blames the remuneration system with misaligned incentives in the German health care system because so many long-term ventilated patients under clinical and especially out-of-hospital intensive care could not be weaned in the past.
According to the study, there is still a rapid increase in tracheotomized patients, so more targeted intervention is needed in high-risk patients. The PRiVENT study project can make this possible because it identifies those affected patients who could go through weaning with the support of interprofessional teams from the certified weaning centers, Trudzinski explains.
While in 2005, there were only 5,000 cases in outpatient care, there are currently an estimated 20,000. 86,000 patients are also in inpatient treatment today, whereas ten years ago, only just under a third (25,000) were in clinics.
According to the expert, the weaning potential must be examined in certified weaning centers. The analysis of 11,424 patients showed that a weaning intervention would be possible and useful in two out of three intensive care patients. In the out-of-hospital sector, this alone could save four billion in costs because long-term ventilation is expensive. However, Trudzinski admits in an interview that certain risk factors, such as a too low BMI, a longer duration of ventilation, neuromuscular diseases, and old age, make specialized ventilation weaning difficult or even impossible.
That is why the PRiVENT project exists, to focus on patients in 40 cooperation hospitals in Baden-Württemberg with intensive care. According to the project, 4,000 have a high risk for long-term ventilation. By assessing the individual risk, however, it is possible to find a preventive approach so that pneumologists, respiratory therapists, and intensive care physicians can determine the weaning potential in so-called weaning boards and consults and thus also reduce costs.
The aQua Institute in Göttingen also helps through cooperation by providing 8,000 billing data from inpatients or potential participants for the Baden-Württemberg project at the Löwenstein Clinic, Schillerhöhe Clinic, Heidelberg University Hospital, and Waldburg-Zeil Acute Care Clinics. Of the 4,000 patients ultimately involved, 1,495 are therefore at risk, as the study has shown to date.
Source: www.aerzteblatt.de