PDF(Pubmed)
Abstract：
UNASSIGNED: Even more than hospital care in general, intensive care and mechanical ventilation capacities and its utilization in terms of rates, indications, ventilation types and outcomes vary largely among countries. We analyzed complete and nationwide data for Germany, a country with a large intensive care sector, before, during and after the COVID-19 pandemic.
UNASSIGNED: Analysis of administrative claims data, provided by the German health insurance, from all hospitals for all individual patients who were mechanically ventilated between 2019 and 2022. The data included age, sex, diagnoses, length of stay, procedures (e.g., form and duration of mechanical ventilation), outcome (dead vs. alive) and costs. We included all patients who were at least 18 years old at the time of discharge from January 1st, 2019 to December 31st, 2022. Patients were grouped according to year, age group and the form of mechanical ventilation. We further analyzed subgroups of patients being resuscitated and those being COVID-19 positive (vs. negative).
UNASSIGNED: During the four years, 1,003,882 patients were mechanically ventilated in 1395 hospitals. Rates per 100,000 inhabitants varied across age groups from 110 to 123 (18-59 years) to 1101-1275 (>80 years). The top main diagnoses were other forms of heart diseases, pneumonia, chronic obstructive pulmonary disease (COPD), ischemic heart diseases and cerebrovascular diseases. 43.3% (437,031/1,003,882) of all mechanically ventilated patients died in hospital with a remarkable increase in mortality with age and from 2019 to 2022 by almost 5%-points. The in-hospital mortality of ventilated COVID-19 patients was 53.7% (46,553/86,729), while it was 42.6% (390,478/917,153) in non-COVID patients. In-hospital mortality varied from 27.0% in non-invasive mechanical ventilation (NIV) only to 53.4% in invasive mechanical ventilation only cases, 59.4% with early NIV failure, 68.6% with late NIV failure, to 74.0% in patients receiving VV-ECMO and 80.0% in VA-ECMO. 17.5% of mechanically ventilated patients had been resuscitated before, of whom 78.2% (153,762/196,750) died. Total expenditure was around 6 billion Euros per year, i.e. 0.17% of the German GDP.
UNASSIGNED: Mechanical ventilation was widely used, before, during and after the COVID-19 pandemic in Germany, reaching more than 1000 patients per 100,000 inhabitants per year in the age over 80 years. In-hospital mortality rates in this nationwide and complete cohort exceeded most of the data known by far.
UNASSIGNED: This research did not receive any dedicated funding.
UNASSIGNED: Analysis of administrative claims data, provided by the German health insurance, from all hospitals for all individual patients who were mechanically ventilated between 2019 and 2022. The data included age, sex, diagnoses, length of stay, procedures (e.g., form and duration of mechanical ventilation), outcome (dead vs. alive) and costs. We included all patients who were at least 18 years old at the time of discharge from January 1st, 2019 to December 31st, 2022. Patients were grouped according to year, age group and the form of mechanical ventilation. We further analyzed subgroups of patients being resuscitated and those being COVID-19 positive (vs. negative).
UNASSIGNED: During the four years, 1,003,882 patients were mechanically ventilated in 1395 hospitals. Rates per 100,000 inhabitants varied across age groups from 110 to 123 (18-59 years) to 1101-1275 (>80 years). The top main diagnoses were other forms of heart diseases, pneumonia, chronic obstructive pulmonary disease (COPD), ischemic heart diseases and cerebrovascular diseases. 43.3% (437,031/1,003,882) of all mechanically ventilated patients died in hospital with a remarkable increase in mortality with age and from 2019 to 2022 by almost 5%-points. The in-hospital mortality of ventilated COVID-19 patients was 53.7% (46,553/86,729), while it was 42.6% (390,478/917,153) in non-COVID patients. In-hospital mortality varied from 27.0% in non-invasive mechanical ventilation (NIV) only to 53.4% in invasive mechanical ventilation only cases, 59.4% with early NIV failure, 68.6% with late NIV failure, to 74.0% in patients receiving VV-ECMO and 80.0% in VA-ECMO. 17.5% of mechanically ventilated patients had been resuscitated before, of whom 78.2% (153,762/196,750) died. Total expenditure was around 6 billion Euros per year, i.e. 0.17% of the German GDP.
UNASSIGNED: Mechanical ventilation was widely used, before, during and after the COVID-19 pandemic in Germany, reaching more than 1000 patients per 100,000 inhabitants per year in the age over 80 years. In-hospital mortality rates in this nationwide and complete cohort exceeded most of the data known by far.
UNASSIGNED: This research did not receive any dedicated funding.
摘要：
■甚至超过一般的医院护理，重症监护和机械通气能力及其利用率，适应症,通风类型和结果在各国之间差异很大。我们分析了德国的完整和全国性的数据，一个拥有大型重症监护部门的国家，之前，在COVID-19大流行期间和之后。
■行政索赔数据分析，由德国健康保险提供，从所有医院为2019年至2022年间进行机械通气的所有个体患者。数据包括年龄,性别,诊断,逗留时间,程序(例如，机械通气的形式和持续时间)，结果(死亡vs.活着)和成本。我们纳入了从1月1日起出院时至少18岁的所有患者，2019年12月31日,2022年。患者按年份分组，年龄组和机械通气的形式。我们进一步分析了复苏患者和COVID-19阳性患者的亚组(vs.负）。
■在这四年中，在1395家医院进行了1,003,882名患者的机械通气。每100,000名居民的比率因年龄组而异，从110至123（18-59岁）到1101-1275（>80岁）。最主要的诊断是其他形式的心脏病，肺炎,慢性阻塞性肺疾病(COPD),缺血性心脏病和脑血管疾病。所有机械通气患者中有43.3％（437,031/1,003,882）在医院死亡，死亡率随着年龄的增长而显着增加，从2019年到2022年，增加了近5个百分点。通气COVID-19患者的院内死亡率为53.7%(46,553/86,729)，而在非COVID患者中，这一比例为42.6%(390,478/917,153)。院内死亡率从只有无创机械通气（NIV）的27.0％到只有有创机械通气的53.4％不等。59.4%的NIV早期失败，68.6%的NIV晚期失败，接受VV-ECMO的患者为74.0%，VA-ECMO为80.0%。17.5%的机械通气患者以前曾复苏过，其中78.2%(153,762/196,750)死亡。总支出每年约60亿欧元，德国GDP的0.17%。
■机械通气被广泛使用，之前，在德国新冠肺炎大流行期间和之后，在80岁以上的人口中，每年每100,000名居民中有1000多名患者。在全国范围内和完整队列中，住院死亡率超过了迄今为止已知的大多数数据。
■这项研究没有获得任何专项资金。
■行政索赔数据分析，由德国健康保险提供，从所有医院为2019年至2022年间进行机械通气的所有个体患者。数据包括年龄,性别,诊断,逗留时间,程序(例如，机械通气的形式和持续时间)，结果(死亡vs.活着)和成本。我们纳入了从1月1日起出院时至少18岁的所有患者，2019年12月31日,2022年。患者按年份分组，年龄组和机械通气的形式。我们进一步分析了复苏患者和COVID-19阳性患者的亚组(vs.负）。
■在这四年中，在1395家医院进行了1,003,882名患者的机械通气。每100,000名居民的比率因年龄组而异，从110至123（18-59岁）到1101-1275（>80岁）。最主要的诊断是其他形式的心脏病，肺炎,慢性阻塞性肺疾病(COPD),缺血性心脏病和脑血管疾病。所有机械通气患者中有43.3％（437,031/1,003,882）在医院死亡，死亡率随着年龄的增长而显着增加，从2019年到2022年，增加了近5个百分点。通气COVID-19患者的院内死亡率为53.7%(46,553/86,729)，而在非COVID患者中，这一比例为42.6%(390,478/917,153)。院内死亡率从只有无创机械通气（NIV）的27.0％到只有有创机械通气的53.4％不等。59.4%的NIV早期失败，68.6%的NIV晚期失败，接受VV-ECMO的患者为74.0%，VA-ECMO为80.0%。17.5%的机械通气患者以前曾复苏过，其中78.2%(153,762/196,750)死亡。总支出每年约60亿欧元，德国GDP的0.17%。
■机械通气被广泛使用，之前，在德国新冠肺炎大流行期间和之后，在80岁以上的人口中，每年每100,000名居民中有1000多名患者。在全国范围内和完整队列中，住院死亡率超过了迄今为止已知的大多数数据。
■这项研究没有获得任何专项资金。
