Weaning in early neurological-neurosurgical rehabilitation in Germany (NurBeat) – Results from a Nationwide online survey

Oliver Summ^1,2Heiko Frers¹Andreas Klausen²Fabian Otto-Sobotka²Marcus Pohl³Rainer Röhrig⁴Tobias Schmidt-Wilcke⁵Kristin Schröder⁶Antje Timmer²Anette Weigel^1,7Thomas Platz^10,8,9Martin Groß^11,12,2,9*

• ¹Evangelisches Krankenhaus Oldenburg, Oldenburg, Germany
• ²Carl von Ossietzky Universitat Oldenburg, Oldenburg, Germany
• ³VAMED Klinik Schloss Pulsnitz GmbH, Pulsnitz, Germany
• ⁴Rheinisch-Westfalische Technische Hochschule Aachen, Aachen, Germany
• ⁵Bezirksklinikum Mainkofen, Deggendorf, Germany
• ⁶Jade Hochschule - Studienort Oldenburg, Oldenburg, Germany
• ⁷Deutsche Gesellschaft für Atmungstherapie (DGA) e.V., Oldenburg, Germany
• ⁸BDH-Klinik Greifswald gGmbH, Greifswald, Germany
• ⁹Deutsche Gesellschaft für Neurorehabilitation (DGNR) e.V., Bonn, Germany
• ¹⁰Universitat Greifswald, Greifswald, Germany
• ¹¹MEDIAN Clinic Bad Tennstedt, Bad Tennstedt, Germany
• ¹²Deutsche Interdisziplinäre Gesellschaft für Außerklinische Beatmung und Intensivversorgung (DIGAB) e.V.), Göttingen, Germany

Background In Germany, on approximately 1100 beds early neurological-neurosurgical rehabilitation (ENNR) is provided to patients with neurological illness needing weaning from mechanical ventilation. Institutions specialized in weaning in ENNR contribute to maintain ICU capacities in acute care hospitals and to reduce the number of patients needing home intensive care. Nationwide structural data on ENNR weaning centers – combined with detailed patient characteristics – are lacking, creating challenges for healthcare planning, resource allocation, and understanding national weaning capacity. Methods In June 2022, an online survey to collect structural data on institutions and wards and cross-sectional clinical data from mechanically ventilated neurological patients was sent to the members of the weaning commission of the DGNR, to participants of a preceding study, and to institutions recruited by personal communication. Findings Data from 24 institutions, 46 wards and 182 patients were recorded. Institutions showed wide variability in diagnostic and therapeutic resources, but most relied on multidisciplinary teams and intensive monitoring, reflecting the high medical complexity of this population. The most frequent primary diagnoses were 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%), and 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) hours during the last 24h before data collection. Fourteen (8%) patients needed renal replacement therapy. Palliative limitations of therapy were implemented in n=22 (12%). Interpretation Institutions providing weaning in ENNR commonly treat older, medically complex patients who have been pretreated in acute intensive care units and who present with severe neurological illness and cardiopulmonary comorbidities. Multidisciplinary teams deliver rehabilitation, intensive care, and palliative care to meet their needs.