# Weaning in early neurological-neurosurgical rehabilitation in Germany – results from a nationwide online survey

## TL;DR

This study provides insights into weaning practices in early neurological-neurosurgical rehabilitation in Germany, highlighting patient characteristics and institutional variability.

## Contribution

The paper presents the first nationwide survey on ENNR weaning centers in Germany, offering structural and clinical data for healthcare planning.

## Key findings

- Most patients had ischemic stroke or intracerebral hemorrhage as primary diagnoses.
- Mechanical ventilation was predominantly invasive, with a median duration of 22 days in ENNR.
- Multidisciplinary teams are common in treating medically complex patients with neurological and cardiopulmonary issues.

## Abstract

In Germany, approximately 1,100 beds are allocated to early neurological-neurosurgical rehabilitation (ENNR) for patients with severe neurological illness requiring weaning from mechanical ventilation. Specialized ENNR institutions play a major role in maintaining ICU capacity in acute care hospitals and in reducing the number of patients dependent on home intensive care. However, nationwide structural data on ENNR weaning centers–together with detailed patient characteristics–remain unavailable. This lack of information poses significant challenges for healthcare planning, resource allocation, and understanding the national weaning capacity.

In June 2022, an online survey was conducted to collect structural data on institutions and wards, as well as cross-sectional clinical data from mechanically ventilated neurological patients. The survey was sent to the members of the weaning commission of the German Society for Neurological Rehabilitation (DGNR), to participants of a preceding study, and also to institutions recruited through personal communication.

Data were collected from 24 institutions, including 46 wards and 182 patients. Institutions showed considerable variability in diagnostic and therapeutic resources; however, most relied on multidisciplinary teams and intensive monitoring, indicating high medical complexity of the patient population. The most frequent primary diagnoses included ischemic stroke (n = 27, 15%), intracerebral hemorrhage (n = 21, 12%), hypoxic–ischemic encephalopathy (n = 12, 7%), and subarachnoid hemorrhage (n = 12, 7%). The most frequent comorbidities were coronary heart disease (n = 40, 22%), left ventricular failure (37, 20%), and COPD (37, 20%). Mechanical ventilation was predominantly invasive (n = 180, 99%). The median number of days on mechanical ventilation during the stay in ENNR was 22 (IQR 9–41) days, and the median duration of ventilation was 18 (IQR 10–24) h during the last 24 h before data collection. Fourteen (8%) patients needed renal replacement therapy. Palliative therapy limitations were implemented in 22 (12%) patients.

Institutions providing weaning in ENNR commonly treat older, medically complex patients who have undergone pretreatment in acute intensive care units. These patients typically present with severe neurological illness accompanied with cardiopulmonary comorbidities. In order to meet their needs, multidisciplinary teams deliver rehabilitation, intensive care, and palliative care.