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

TL;DR

A German study found that patients needing home-based intensive care after neurological rehabilitation have high mortality, with older age and longer ventilation use linked to worse outcomes.

Contribution

This study provides new insights into long-term survival rates and predictors of mortality in patients requiring home-based intensive care after neurological rehabilitation.

Findings

One-year survival rate was 61.9%, dropping to 38.1% after four years.

Older age, higher morbidity, and discharge with mechanical ventilation were linked to higher mortality.

Longer stays in neurological rehabilitation correlated with better survival.

Abstract

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.

The online version contains supplementary material available at 10.1186/s42466-025-00384-1.

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