Out-of-Hospital Intensive Care in Germany - who´s out there? Key issues revealed by the clinical application of the new legislation in Baden Württemberg.

INTRODUCTION: Against the background of 20,000+ patients in need of out-of-hospital intensive care in Germany, the new legislation aims to optimize medical care and strengthen the rehabilitation potential in this vulnerable group, including the stipulation that intensive care must be prescribed and optimized by doctors experienced in intensive care. The present study aims to present the first results of this intervention. METHODS: Respiratory physician and therapist from Loewenstein Weaning Center examined 148 consecutive adult patients between October 2023 and February 2026 and evaluated their weaning potential. The patient-history data were analyzed retrospectively. Descriptive statistics were used to describe the patients' demographic characteristics and clinical profile, indication for intensive care, weaning potential and the results of subsequent weaning/decannulation attempts. RESULTS: A total of 148 consecutive patients were evaluated: 140 (94.6%) on-site and 8 (5.4%) telemedically. 69 (46.6%) resided in specialized respiratory care communities, 71 (48.0%) in nursing homes, and 8 (5.4%) at home. The mean age was 61.2 ± 13.2 years, and 111 (75.0%) patients were male. Tracheostomy was present in 138 (93.2%) patients, of whom 34 (24.6% of the tracheostomized cohort; 23.0% of the total population) were also invasively ventilated. 10 (6.8%) patients used non-invasive ventilation. Neurological impairment (primary or secondary) led to tracheostomy in 106 (76.8%) patients, while the second leading cause was pulmonary disease in 18 (13.0%) patients. Of the invasively ventilated patients, 6/34 (17.6%) were successfully weaned. A total of 47/138 (34.1%) patients had short- or long-term decannulation potential. Specifically, 19/138 (13.8%) patients with short-term potential were successfully decannulated (including the 6 previously weaned patients), and 28/138 (20.3%) patients with long-term potential were referred for neurological rehabilitation. Following re-evaluation, 3/10 (30.0%) non-invasively ventilated patients no longer required out-of-hospital intensive care. CONCLUSION: Only a quarter of out-patients requiring intensive care are invasively ventilated. Adequate care for ventilated patients should be coordinated by weaning centers in order to exploit the existing weaning potential. Access to rehabilitation is a decisive factor in maximizing the long-term decannulation potential.