Trends in home mechanical ventilation in the first year of the COVID-19 pandemic in Germany: a routine data analysis

Background: Routine data have shown a stark increase in home mechanical ventilation (HMV) in Germany in recent years. However, the development of HMV in the first year of the COVID-19 pandemic is unknown. Methods: Case numbers of initiations, control examinations, and terminations of invasive and non-invasive HMV in 2017-2020 were analysed. ICD-10 diagnoses of cases with an initiation of invasive HMV in 2017- 2020 were examined (data from the German Federal Statistical Office). Expenses of the statutory health insurances for ambulatory intensive care in 2017-2020 were analysed (data from the German Federal Ministry of Health). Results: Contrary to the trend in recent years, HMV initiations declined by 14.9 % in 2020, from n = 17,958 (2019) to n = 15,279 (2020). This development was due to a 15.9 % decline in initiations of non-invasive HMV. In contrast, initiations of invasive HMV remained stable in 2020, despite regional differences. For invasive and non-invasive HMV, control examinations (-28 % and -24 %, respectively) and ventilation terminations (-45.3 % and -15.1 %, respectively) dropped in 2020. Patients for whom invasive HMV was initiated had numerous comorbidities and care needs. Expenses of statutory health insurances for ambulatory intensive care increased from EUR 1.52 billion (2017) to EUR 2.16 billion (2020; +42.3 %). Conclusions: After an increase in control examinations and terminations of HMV in recent years, we observe a trend reversal in 2020. Additionally, initiations of non-invasive HMV decreased in 2020. Future studies need to explore the association between this development and the COVID-19 pandemic.