Abstract:PRiVENT (Prevention of Invasive Ventilation through Early Identification and Early Intervention in Patients at Risk) is a cross-sectoral care model developed within the framework of the Innovation Fund of the German Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA). The aim of the project was to identify patients at increased risk of prolonged mechanical ventilation at an early stage and to promote successful weaning from mechanical ventilation through the early involvement of certified weaning centres and structured, interprofessional interventions. By doing so, the project seeks to prevent long-term invasive mechanical ventilation, tracheostomy, and the need for long-term out-of-hospital intensive care.Based on the initial positive results of the Innovation Fund project, a selective integrated care contract pursuant to § 140a of the German Social Code Book V (SGB V) was developed in collaboration with AOK Baden-Württemberg. The objective of this contract was to sustainably transfer the care structures established during the project into routine clinical care and to make them available throughout Baden-Württemberg for insured members of AOK Baden-Württemberg.The core components of the PRiVENT care pathway are the Weaning Board and the Weaning Consultation, both of which are conducted by an interprofessional team consisting of at least a pulmonologist and a respiratory therapist from a certified specialised weaning centre. Consultations may be performed via telemedicine, in a hybrid format, or entirely on site. The following section describes the healthcare services provided within the PRiVENT selective care contract under § 140a SGB V.

Background Despite the increasing number of patients receiving long-term invasive mechanical ventilation (IMV) and the social importance of this issue, it is largely neglected in the public perception. One aim of the PRIVENT project was to raise public awareness of the issue.Methods A team of physicians, health researchers, an art director and a scientific editor developed an information campaign, including blog posts, podcasts, social media posts and information for medical professionals or patients/their relatives and made them available to the public on a dedicated homepage and various social media platforms. The number of views was used to measure the reach of the campaign.Results In the period from 02/2021-03/2025, a total of 72 blog posts and 880 social media posts and 3 podcast seasons with 21 episodes were made available to the public. The total reach was 2.6 million, with Facebook, Instagram and LinkedIn being the most used platforms with a total of 1872 followers. The most popular blog posts were those that explained the basics of IMV in plain language. Followers of the different social networks differ. Instagram users are younger and more likely to be female than those on Facebook and LinkedIn.Conclusion Our analysis shows that social media can increase the visibility of long-term invasive mechanical ventilation and reach diverse audiences. Although visibility does not equate to awareness, these findings highlight the potential of social media to support broader communication about long-term IMV and weaning within the medical community and society. Trial registration number: The PRiVENT study is registered at ClinicalTrials.gov (NCT05260853) on 02/03/2022.

Introduction: The multicentre cluster-randomized PRiVENT study aims to improve weaning of long-term ventilated patients in German intensive care units via a complex interprofessional intervention. To assess perceptions on interprofessional collaboration and job satisfaction among different health professions, a survey was conducted in four clusters, each comprising one weaning centre and 7-12 cooperation hospitals. METHODS:Three validated questionnaires were used to measure (a) interprofessional socialization (7-level Likert scale), (b) interprofessional collaboration (5-level), and (c) job satisfaction (7-level). Alongside a descriptive analysis, a subgroup analysis was performed comparing mean scores between physicians and non-physicians and the four clusters. Correlation coefficients were calculated to check for correlations of age group and work experience with interprofessional collaboration and job satisfaction. RESULTS:Sixty-two questionnaires were returned by health workers of the intensive care units, corresponding to a response rate of 47%. Respondents rated interprofessional socialization (5.7 ± 0.6) and collaboration (3.8 ± 0.6) as good. Job satisfaction was high (5.1 ± 1.0), particularly regarding the collegial environment and variety of work tasks. Satisfaction with physical workload, income, and working hours was lower. Compared to physicians, overall ratings of non-physicians were lower, although the differences were not statistically significant, as were those between clusters. There was a statistically significant positive correlation of age group and work experience with overall job satisfaction. CONCLUSION:Health workers within PRiVENT are satisfied with their workplace conditions and rate interprofessional collaboration as good. Follow-up surveys will provide insights into the impact of PRiVENT on interprofessional cooperation and job satisfaction. .

Sex differences in intensive care medicine, particularly regarding risk factors for (MV), are underexplored. This study aimed to investigate sex-related risk factors for long-term MV. We analyzed claims data from patients aged ≥ 30, with at least one comorbidity, who received MV (≥ 96 h) between 2015 and 2018. Data covered 365 days prior to hospitalization and 30 days post-discharge. Sex differences in 29 predefined risk factors were assessed. Over 12,000 hospitalizations were analyzed, with 37.8% of patients being female. Women were older (71.3 ± 11.6 vs. 69.9 ± 11.2 years, p < 0.001) and more often transferred from nursing homes (4.5% vs. 2.7%, p < 0.001). Men required invasive long-term ventilation more often (33.8% vs. 31.2%, p = 0.004) and had more ventilation hours (400.0 ± 377.9 vs. 373.0 ± 341.8, p < 0.001). Among pre-existing conditions, women had more thyroiditis and rheumatic mitral valve disease, while men had more COPD, cardiac arrhythmia, eating disorders, and acute pancreatitis. Men were more likely to undergo bronchoscopy, autologous blood transfusion, or Extracorporeal life support (ECLS) within 96 h of MV. Multivariate analyses revealed stronger associations between certain risk factors and long-term MV by sex. For men, thyroiditis (OR 2.7 vs. 1.4 in women), cerebral infarction (OR 2.3 vs. 1.4), and acute pancreatitis (OR 3.2 vs. 1.0) were more strongly linked to weaning failure. For women, cerebrospinal fluid surgery (OR 5.7 vs. 2.0 in men) and acute pancreatitis (OR 4.7 vs. 3.0 in men) had stronger associations with long-term MV. ECLS and eating disorders were only linked to long-term MV in men. This study highlights sex differences in risk factors and outcomes for long-term MV, suggesting the need for sex-specific management strategies. Trial registration: The PRiVENT study was retrospectively registered at ClinicalTrials.gov (NCT05260853). Registered at March 2, 2022.

Background: The PRiVENT study aims to reduce the number of long-term ventilated patients by improving interprofessional collaboration among healthcare professionals. To assess the current state of interprofessional cooperation and job satisfaction in intensive care units, a written survey was conducted among service providers from four clusters, each of which consist of one weaning centre and 7-12 other cooperation hospitals. Methods: The Interprofessional Socialization and Valuing Scale, Assessment of Interprofessional Team Collaboration Scale and the Warr-Cook-Wall Scale were used. In addition to a descriptive analysis, a subgroup analysis was performed comparing scores between physicians and non-physicians and the four clusters. Correlation coefficients were calculated to check for correlations between age group and gender with interprofessional collaboration and work satisfaction. Internal consistency of the questionnaires was assessed via Crohnbach’s Alphas. Analyses were performed using Excel version 1808 and R (version 4.0.3). Results: A total of 60 questionnaires were filled out by health workers at the WCs and CCs participating in the project, corresponding to a response rate of 46%. 36 (59%) questionnaires were completed by physicians and 24 (41%) by the other health professionals. The average work experience was 18.4 ± 11.4 years. Most respondents rated their personal teamwork skills and interprofessional cooperation as good. Job satisfaction was high, particularly regarding the collegial environment and variety of work tasks. Satisfaction with physical workload, income, and working hours was lower. Non-physicians’ ratings were lower for all questionnaires and most items, although the difference in total scores was not statistically significant. No statistically significant differences were observed between clusters. There was a statistically significant positive monotonous correlation between age group and years of work experience with overall work satisfaction. Internal consistency of the questionnaires was excellent. Conclusions: The findings show that staff members are generally satisfied with their workplace conditions and environment and rate their individual team skills and interprofessional cooperation as good. Non-physicians were less satisfied with their working conditions, although the difference was not statistically significant. Future surveys at mid-term and at the end of the intervention period will provide insights into the impact of PRiVENT on interprofessional cooperation and job satisfaction. Registration The study protocol of the PRiVENT study was registered on 02.03.2022 in the German Register of Clinical Trials under the number DRKS00028196.

BACKGROUND:Established structured weaning approaches, which are effective for patients in simple and difficult weaning, are often not appropriate for patients undergoing prolonged weaning. Addressing the complexity of weaning failure requires personalized precision medicine. The therapeutic concept of treatable traits (TTs) has been proposed as a new paradigm for the management of chronic respiratory diseases. It is based on a multidimensional assessment of specific characteristics, which can be addressed by specific interventions that go beyond traditional diagnostic criteria. The concept is increasingly adopted for other complex diseases. SUMMARY:This is a narrative review and an expert opinion on the development of a concept of TTs for patients undergoing prolonged weaning. The proposed TTs are based on a systematic review of risk factors for prolonged weaning, an analysis of claims data to assess risk factors within 96 h of IMV onset and data from the WEAN SAFE study. A multidisciplinary team identified clinically important TTs and determined appropriate interventions. The following TTs have been identified: airway disorders and complications associated with tracheostomy or intubation, such as airway obstruction, strictures or tracheomalacia, infectious aspects, anxiety, depression, delirium, post-traumatic stress disorder, anemia, pulmonary and cardio-renal disease. The multidimensional holistic approach also includes tailored sedation and pain management, nutritional therapy, early mobilization, and physiotherapy. KEY MESSAGE:We propose a framework of relevant considerations for a multidimensional approach to the management of patients undergoing prolonged weaning that supports the regain of respiratory capacity, reduces the respiratory load, and thus could resolve the respiratory workload imbalance.

Background Long-term invasive mechanical ventilation (IMV) is a major burden for those affected and causes high costs for the health care system. Early risk assessment is a prerequisite for the best possible support of high-risk patients during the weaning process. We aimed to identify risk factors for long-term IMV within 96 h (h) after the onset of IMV. Methods The analysis was based on data from one of Germany's largest statutory health insurance funds; patients who received IMV ≥ 96 h and were admitted in January 2015 at the earliest and discharged in December 2017 at the latest were analysed. OPS and ICD codes of IMV patients were considered, including the 365 days before intubation and 30 days after discharge. Long-term IMV was defined as evidence of invasive home mechanical ventilation (HMV), IMV ≥ 500 h, or readmission with (re)prolonged ventilation. Results In the analysis of 7758 hospitalisations, criteria for long-term IMV were met in 38.3% of cases, of which 13.9% had evidence of HMV, 73.1% received IMV ≥ 500 h and/or 40.3% were re-hospitalised with IMV. Several independent risk factors were identified (p < 0.005 each), including pre-diagnoses such as pneumothorax (OR 2.10), acute pancreatitis (OR 2.64), eating disorders (OR 1.99) or rheumatic mitral valve disease (OR 1.89). Among ICU admissions, previous dependence on an aspirator or respirator (OR 5.13), and previous tracheostomy (OR 2.17) were particularly important, while neurosurgery (OR 2.61), early tracheostomy (OR 3.97) and treatment for severe respiratory failure such as positioning treatment (OR 2.31) and extracorporeal lung support (OR 1.80) were relevant procedures in the first 96 h after intubation. Conclusion This comprehensive analysis of health claims has identified several risk factors for the risk of long-term ventilation. In addition to the known clinical risks, the information obtained may help to identify patients at risk at an early stage. Trial registration The PRiVENT study was retrospectively registered at ClinicalTrials.gov (NCT05260853). Registered at March 2, 2022.

Background PRiVENT (PRevention of invasive VENTilation) is an evaluation of a bundle of interventions aimed at the prevention of long-term invasive mechanical ventilation. One of these elements is an e-learning course for healthcare professionals to improve weaning expertise. The aim of our analysis is to examine the implementation of the course in cooperating intensive care units.Methods The course has been developed through a peer review process by pulmonary and critical care physicians in collaboration with respiratory therapists, supported by health services researchers and a professional e-learning agency. The e-learning platform "weLearn" was made available online to participating healthcare professionals. Feedback on the e-learning programme was obtained and discussed in quality circles (QCs). We measured the acceptance and use of the programme through access statistics.Results The e-learning course "Joint Prevention of Long-Term Ventilation" consists of 7 separate modules with practice-oriented training units as well as a cross-module area and corresponding interactive case studies. Users can receive 23 CME (continuing medical education) credits. The platform was released on July 1, 2021. By June 28, 2023, 214 users from 33 clinics had registered. Most users (77-98%) completed the modules, thus performing well in the test, where 90-100% passed. In the QCs, the users commended the structure and practical relevance of the programme, as well as the opportunity to earn CME credits.Conclusion Especially for medical staff in intensive care units, where continuous training is often a challenge during shift work, e-learning is a useful supplement to existing medical training.Trial registration The PRiVENT study is registered at ClinicalTrials.gov (NCT05260853) on 02/03/2022.

Invasive mechanical ventilation (IMV) is a standard therapy for intensive care patients with respiratory failure. With increasing population age and multimorbidity, the number of patients who cannot be weaned from IMV increases, resulting in impaired quality of life and high costs. In addition, human resources are tied up in the care of these patients. The PRiVENT intervention is a prospective, mixed-methods interventional, multicentre study with a parallel comparison group selected from insurance claims data of the health insurer Allgemeine Ortskrankenkasse Baden-Württemberg (AOK-BW) conducted in Baden-Württemberg, Germany, over 24 months. Four weaning centres supervise 40 intensive care units (ICUs), that are responsible for patient recruitment. The primary outcome, successful weaning from IMV, will be evaluated using a mixed logistic regression model. Secondary outcomes will be evaluated using mixed regression models. The overall objective of the PRiVENT project is the evaluation of strategies to prevent long-term IMV. Additional objectives aim to improve weaning expertise in and cooperation with the adjacent Intensive Care Units. This study is registered at ClinicalTrials.gov (NCT05260853).

Background: Despite the increasing number of patients receiving invasive long-term invasive mechanical ventilation (IMV) and the social importance of this issue, its public perception stays low. Therefore, the German PRiVENT project aims to raise public awareness for long-term ventilation. Methods: A multi-professional team of physicians, health researchers, art directors and copywriters developed an extensive information campaign, including blog posts, podcasts, social media posts and information for medical professionals or patients/their relatives and made them available to the public on a dedicated homepage and various social media platforms (Facebook, Instagram, YouTube, Linkedin and DocCheck). In this analysis, we assessed the scope of the campaign based on the number of views or klicks measured on the various platforms. Results In the period from Feb. 21 to Feb. 22, a total of 45 blog posts, 489 posts on social media and 3 podcast seasons with a total of 15 episodes were published. The total reach was 2.2 million views, with Facebook and Instagram being the most used platforms with a total of 324 followers, 2.1 million views. Compared to Facebook (35-44 years), Instagram users were younger (age peak 25-30 vs. 35-44 years) and more often female (65.8% vs. 60.8%). Conclusion: The results show that social media can be used to raise awareness of long-term IMV among a younger target audience. With an issue of such relevance, the public should be involved to empower patients and their families and to highlight the importance of ventilator weaning in the medical community and in society9s perception.

Hintergrund Ziel der vom Innovationsfonds des GBA geförderten Interventions-Studie (PRiVENT – 01NVF19023) ist es, die Zahl der langzeitbeatmeten Patienten zu reduzieren. Ein Aspekt ist hierbei die Steigerung der Weaning-Kompetenz der beteiligten Krankenhäuser. Neben Fortbildungsveranstaltungen und Qualitätszirkeln wird im Rahmen des Projektes eine E-Learning-Plattform zum Selbststudium bereitgestellt. Das Angebot wurde für Angehörigen verschiedener medizinischer Berufsgruppen entwickelt. Die Akzeptanz des E-Learning wurde anhand der Teilnehmerzahlen und des Feedbacks der Nutzer untersucht.

Zusammenfassung Hintergrund Das Projekt PRiVENT hat sich zum Ziel gesetzt, die Versorgung von invasiv beatmeten Patient*innen zu verbessern und die Anzahl der außerklinischer Langzeitbeatmungspatient*innen zu reduzieren. PRiVENT bietet Intensivstationen die Möglichkeit, sich in interprofessionellen Weaning-Boards und Weaning-Konsilen mit Expert*innen aus spezialisierten Weaning-Zentren auszutauschen und das volle Weaning-Potenzial der Patient*innen auszuschöpfen. Im Rahmen der begleitenden Prozessevaluation werden die PRiVENT-Interventionskomponenten auf Nachhaltigkeit, Skalierbarkeit und Wirksamkeit untersucht sowie die interprofessionelle Zusammenarbeit zwischen Intensivstationen und den zuständigen Weaning-Zentren untersucht, um Potenziale für die Versorgung von invasiv betreuten Patient*innen identifizieren zu können. Methode In einer qualitativen Querschnittsstudie wurden semistrukturierte, problemorientierte Interviews mit Leistungserbringenden teilnehmender Intensivstationen durchgeführt. Die Daten wurden digital aufgezeichnet, pseudonymisiert und verbatim transkribiert. Die Datenanalyse erfolgte in Anlehnung an die Thematic Analysis nach Brown und Clarke und dem Consolidated Framework for Implementation Research. Zur Organisation der Daten wurde die Software MAXQDA 2020 verwendet. Ergebnisse Es wurden 14 Interviews mit den Leistungserbringenden der Intensivstationen geführt. Als positiv wahrgenommene Potenziale der Weaning-Boards und Weaning-Konsile wurden die frühzeitige Verlegung von Patient*innen in ein Weaning-Zentrum sowie die Integration von pulmologischem Fachwissen in die Routineversorgung identifiziert. Insbesondere bei schwerkranken, multimorbiden an COVID-19 erkrankten Patient*innen wurde die Expertise der Weaning-Zentren als hilfreich angesehen. Aufgrund der hohen Arbeitsbelastung konnte das Pflegepersonal nicht an den Weaning-Boards und Weaning-Konsilen teilnehmen. Schlussfolgerung Die Interprofessionelle Zusammenarbeit zwischen Weaning-Zentren und Intensivstationen in Weaning-Boards und Weaning-Konsilen kann die Versorgung invasiv beatmeter Patient*innen verbessern. Strategien zur Förderung des Einbezugs von Pflegefachkräften sollten diskutiert und erarbeitet werden.

Background The PRiVENT project aims to improve the care of invasively ventilated patients and to reduce the number of out-of-hospital long-term ventilated patients. PRiVENT offers intensive care units the opportunity to exchange information with experts from specialized weaning centers in interprofessional weaning boards and weaning consults and to exploit the full weaning potential of the patients. In the context of the accompanying process evaluation, the PRiVENT intervention components will be examined for sustainability, scalability and effectiveness, and the interprofessional collaboration between intensive care units and the responsible weaning centers will be investigated in order to identify potentials for the care of invasively managed patients.Methods In a qualitative cross-sectional study, semistructured, problem-oriented interviews were conducted with care providers of participating ICUs. The data were digitally recorded, pseudonymized and verbatim transcribed. Data analysis was based on Brown and Clarke's Thematic Analysis and the Consolidated Framework for Implementation Research. MAXQDA 2020 software was used to organize the data.Results Fourteen interviews were conducted with ICU care providers. The early transfer of patients to a weaning center and the integration of pulmonary expertise into routine care were identified as positively perceived potentials of the weaning boards and weaning consults. Especially in critically ill, multimorbid patients suffering from COVID-19, the expertise of the weaning centers was considered helpful. Due to heavy workloads, nurses were unable to participate in weaning boards and weaning consults.Conclusion Interprofessional collaboration between weaning centers and ICUs in weaning boards and weaning consults can improve the care of invasively ventilated patients. Strategies to promote the involvement of nurses should be discussed and developed.

INTRODUCTION:Prolonged mechanical ventilation (PMV) and weaning failure are factors associated with prolonged hospital length of stay and increased morbidity and mortality. In addition to the burden these places on patients and their families, it also imposes high costs on the public health system. The aim of this systematic review was to identify risk factors for PMV and weaning failure.METHODS:The study was conducted according to PRISMA guidelines. After a comprehensive search of the COCHRANE Library, CINHAL, Web of Science, MEDLINE, and the LILACS Database a PubMed request was made on June 8, 2020. Studies that examined risk factors for PMV, defined as mechanical ventilation ≥96 h, weaning failure, and prolonged weaning in German and English were considered eligible; reviews, meta-analyses, and studies in very specific patient populations whose results are not necessarily applicable to the majority of ICU patients as well as pediatric studies were excluded from the analysis. This systematic review was registered in the PROSPERO register under the number CRD42021271038.RESULTS:Of 532 articles identified, 23 studies with a total of 23,418 patients met the inclusion criteria. Fourteen studies investigated risk factors of PMV including prolonged weaning, 9 studies analyzed risk factors of weaning failure. The concrete definitions of these outcomes varied considerably between studies. For PMV, a variety of risk factors were identified, including comorbidities, site of intubation, various laboratory or blood gas parameters, ventilator settings, functional parameters, and critical care scoring systems. The risk of weaning failure was mainly related to age, previous home mechanical ventilation (HMV), cause of ventilation, and preexisting underlying diseases. Elevated PaCO2 values during spontaneous breathing trials were indicative of prolonged weaning and weaning failure.CONCLUSION:A direct comparison of risk factors was not possible because of the heterogeneity of the studies. The large number of different definitions and relevant parameters reflects the heterogeneity of patients undergoing PMV and those discharged to HMV after unsuccessful weaning. Multidimensional scores are more likely to reflect the full spectrum of patients ventilated in different ICUs than single risk factors.

Einleitung: Mit PRiVENT ist ein vom Innovationsfond des GBA gefördertes Projekt (01NVF19 023, Start 07/20), welches sich zum Ziel gesetzt hat, über vier Jahre Laufzeit den Weaningerfolg bei Patienten mit Langzeitbeatmung in Baden-Württemberg zu verbessern. Für die Beatmungsentwöhnung nach stattgehabter akutmedizinscher Versorgung gibt es eine Reihe zertifizierter Weaningzentren (WZ). Bis zu 85% der Patienten, die invasiv beatmet entlassen werden, haben in Deutschland keinen Zugang zu einem WZ gehabt. Zudem ist Weaning-Erfolg maßgeblich davon abhängig, dass der Weaning-Prozess frühzeitig multiprofessionell erfolgt. Es wird nicht möglich sein, alle Patienten im prolongierten Weaning diesen WZ zuzuführen, daher will PRiVENT das Fachwissen aus den Expertenzentren in die Regelversorgung überführen.