Predicting and preventing long-term invasive ventilation - a project presentation of PRiVENT

Noemi Sturm, Florian Bornitz, Jan Meis, Dorothea Kronsteiner, Timm Frerk, Joachim Szecsenyi

Specialised weaning treatment proved to successfully wean patients who had failed spontaneous breathing trials and would otherwise depend on continuous invasive ventilation.
Therefore, PRiVENT will develop a prognosis model to detect patients at risk of long-term invasive ventilation offering expertise to wean those in non-specialised clinics.
The study commences in July 2021 and is funded by Germany’s innovation fund (01NVF19023).

Research questions:
Does the PRiVENT-intervention raise the chance to wean patients at high risk of long-term invasive ventilation?

PRiVENT is a prospective, interventional, unblinded, non-randomised multicentre study with a partially parallel control group using healthcare claims data from AOK BW. Inclusion criteria are invasive ventilation for ≥96 hours, ≥30 years of age and at least 1 comorbidity, excluding neuromuscular diseases.

The prognosis model will be set up by clinical expertise, literature review and healthcare claims data. Four weaning-centres will cooperate with 40 ICUs within Baden-Württemberg. Knowledge and therapy recommendations will be exchanged in interprofessional weaning boards and weaning councils to treat ≈1,500 high-risk patients. Discharge and quality management, e-learning, and publicity work will complement the intervention.

The primary endpoint will be investigated using a mixed logistic regression model incorporating random effects to control for the clustering effect of centres. Secondary endpoints will be analysed descriptively.
Further, health economic analyses and process evaluation will be conducted.

The PRiVENT-intervention is expected to identify patients’ risk for long-term invasive ventilation, to wean those at risk and, conversely, decrease the number of ventilated patients.

If the study demonstrates to prevent long-term invasive ventilation, the PRiVENT-intervention may be integrated into standard health-services. Thereby, improving patients’ and relatives’ quality of life, reducing costs in outpatient care, closing knowledge gaps, and strengthening the role of special therapists and interprofessional teamwork.

Points for discussion:
1. From a GPs’ perspective, how could transition from inpatient to outpatient care be improved in these patient groups a) successfully weaned vs. b) requiring invasive ventilation)?

2. How could GPs best get involved and contribute to better care of ventilated patients?