[Improving Specialist Care for Patients in Out-of-Hospital Intensive Care through Regular Pulmonological Video Consultations: A Real-life Study].

Abstract

Background: In recent years, there has been a significant increase in the number of patients requiring out-of-hospital intensive care. Although many of these patients are invasively ventilated, pulmonological care is often lacking. Additionally, up to 60-70% of these patients are suspected to have further potential for weaning. A telemedicine approach to assess weaning potential and provide pulmonological care has not yet been studied.

Methods: From March 2021 to February 2024, we conducted telemedicine pulmonological consultations in four respiratory care groups. A medical history interview and the assessment of parameters such as ventilation measurements were performed via a video portal. In addition, a portable blood gas analysis (BGA) device and a digital stethoscope were used. Treatment recommendations were implemented by the primary care physicians. These data were compared with a control group from four respiratory care groups that did not receive pulmonological care.

Results: A total of 71 tracheotomized patients, regardless of their weaning potential, were included in the telemedicine group. Of these, 40 were breathing spontaneously and 31 were mechanically ventilated (weaning stages 3aII and 3cI respectively). The ventilation duration of 23/31 (74%) patients in the telemedicine group was successfully reduced: 5/31 (16%) required only nocturnal ventilation, and in 4/31 (13%), ventilation was completely discontinued. In a control group of 63 patients (3aII: n=34, 3cI: n=29), only 1/29 (3%) experienced a reduction in ventilation time.In the telemedicine group, 11/71 (15%) patients were admitted for decannulation (3aII: n=6, 3cI: n=5). Of these, 7/11 (64%) were successfully decannulated (3aII: n=3, 3cI: n=4), with an average hospital stay reduced to 9 days. In the control group, 3/63 (5%) patients were admitted for decannulation, but none were successfully decannulated. One patient was successfully decannulated during a hospital stay for another reason.In addition, 310 tele-pulmonological therapy modifications were made in the intervention group, corresponding to 978 patient months: 1/3 patients required a therapy modification per month.

Conclusion: Tele-pulmonological care in out-of-hospital intensive care allows for the identification of weaning potential, the targeted planning of hospital stays for weaning, and the avoidance of unnecessary hospitalizations. Moreover, it improves patient treatment outcomes. Regular monitoring at individualized intervals is necessary for this approach.