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

Bernadette Einhäupl^#¹, Danae Götze^#², Stephanie Reichl³, Lina Willacker¹, Romy Pletz³, Thomas Kohlmann⁴, Esther Henning⁴, Lena Schmeyers⁵, Andreas Straube¹, Rebekka Süss⁵, Steffen Fleßa⁵, Simone Schmidt⁶, Jens D Rollnik⁶, Friedemann Müller⁷, Aukje Bartsch-de Jong⁷, Svenja Blömeke⁷, Jennifer Hartl⁷, Nuria Vallejo⁸, Daniel Liedert⁸, Thomas Olander⁸, Volker Ziegler⁹, Renate Weinhardt⁹, Felix Schlachetzki¹⁰, Tatjana Groß¹⁰, Susanne Hirmer¹⁰, Lea Dillbaner¹⁰, Lisa Kleinlein¹¹, Thomas Platz^#^{3

12}, Andreas Bender^#^{1

8

13}

Affiliations

¹ Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany.
² Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany. Danae.goetze@med.uni-muenchen.de.
³ Neurorehabilitation Research Group, Faculty of Medicine, University of Greifswald, Greifswald, Germany.
⁴ Institute for Community Medicine, Department Methods of Community Medicine, University Medicine Greifswald, Greifswald, Germany.
⁵ Faculty of Law and Economics, Chair of General Business Administration and Health Care Management, University Greifswald, Greifswald, Germany.
⁶ Institute for Neurorehabilitation Research (InFo), BDH-Clinic Hessisch Oldendorf, Affiliated Institute of Hannover Medical School, Hessisch Oldendorf, Germany.
⁷ Schön Clinic Bad Aibling-Harthausen, Bad Aibling, Germany.
⁸ Therapiezentrum Burgau, Hospital for Neurological Rehabilitation, Burgau, Germany.
⁹ Hospital for Neurological Rehabilitation, Rhön-Clinic, Bad Neustadt a. d. Saale, Germany.
¹⁰ Department of Neurology, Centre of Vascular Neurology and Intensive Care, medbo Bezirksklinikum Regensburg, University of Regensburg, Regensburg, Germany.
¹¹ Statistical Consulting StaBLab, Department of Statistics, LMU Munich, Munich, Germany.
¹² BDH-Klinik Greifswald, Institute for Neurorehabilitation and Evidence‑Based Practice, University of Greifswald, Greifswald, Germany.
¹³ Department of Neurorehabilitation, Medical Faculty, University of Augsburg, Augsburg, Germany.

^# Contributed equally.

PMID: 40394723
PMCID: PMC12093594
DOI: 10.1186/s42466-025-00384-1

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

Bernadette Einhäupl et al. Neurol Res Pract. 2025.

. 2025 May 19;7(1):35.

doi: 10.1186/s42466-025-00384-1.

Authors

Affiliations

¹ Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany.
² Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany. Danae.goetze@med.uni-muenchen.de.
³ Neurorehabilitation Research Group, Faculty of Medicine, University of Greifswald, Greifswald, Germany.
⁴ Institute for Community Medicine, Department Methods of Community Medicine, University Medicine Greifswald, Greifswald, Germany.
⁵ Faculty of Law and Economics, Chair of General Business Administration and Health Care Management, University Greifswald, Greifswald, Germany.
⁶ Institute for Neurorehabilitation Research (InFo), BDH-Clinic Hessisch Oldendorf, Affiliated Institute of Hannover Medical School, Hessisch Oldendorf, Germany.
⁷ Schön Clinic Bad Aibling-Harthausen, Bad Aibling, Germany.
⁸ Therapiezentrum Burgau, Hospital for Neurological Rehabilitation, Burgau, Germany.
⁹ Hospital for Neurological Rehabilitation, Rhön-Clinic, Bad Neustadt a. d. Saale, Germany.
¹⁰ Department of Neurology, Centre of Vascular Neurology and Intensive Care, medbo Bezirksklinikum Regensburg, University of Regensburg, Regensburg, Germany.
¹¹ Statistical Consulting StaBLab, Department of Statistics, LMU Munich, Munich, Germany.
¹² BDH-Klinik Greifswald, Institute for Neurorehabilitation and Evidence‑Based Practice, University of Greifswald, Greifswald, Germany.
¹³ Department of Neurorehabilitation, Medical Faculty, University of Augsburg, Augsburg, Germany.

^# Contributed equally.

PMID: 40394723
PMCID: PMC12093594
DOI: 10.1186/s42466-025-00384-1

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Trial registration: 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.

Keywords: Mechanical ventilation; Rehabilitation; Stroke; Survival rate; Tracheal cannula; Weaning.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the Ethics Committee of the Medical Faculty of LMU Munich (Project Number 21-1091) with a letter of confirmation dating from 09.12.2021. The latest version of the protocol (No. 4; dating from 06.09.2022) serving as the basis of the publication received ethics approval on 26.09.2022. Important protocol modifications (e.g., changes to eligibility criteria, outcomes, analyses) to relevant parties (e.g., investigators, institutional review board, trial participants, trial registry) were communicated by the study coordinating center (LMU). Written informed consent was obtained from all subjects before entering the study. Study patients or their legal representatives were informed about the study by the previously treating NER clinic by post and were asked to provide their informed written consent. For patients who could not be contacted after two attempts, endpoints of the retrospective study part were collected fully anonymized based on the medical records of the discharging NER facility and status of survival was collected by Residents’ Registration Office query. For the follow-up interview, written informed consent had to be provided by the patients (or by their legal representative if the patient was not able to consent) before data collection was performed. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests.

Figures

**Fig. 1**
Kaplan-Meier estimates of time to death by (A) Total study sample; (B) Gender; (C) Age groups and (D) Discharge with TC only or TC and MV

See this image and copyright information in PMC

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

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