Faculty Collaboration Database

Mechanical ventilation weaning and extubation after spinal cord injury: a Western Trauma Association multicenter study. J Trauma Acute Care Surg 2013 Dec;75(6):1060-9; discussion 1069-70

Date

11/22/2013

Pubmed ID

24256682

Pubmed Central ID

PMC3837348

DOI

10.1097/TA.0b013e3182a74a5b

Scopus ID

2-s2.0-84890089023 (requires institutional sign-in at Scopus site)   36 Citations

Abstract

BACKGROUND: Respiratory failure after acute spinal cord injury (SCI) is well recognized, but data defining which patients need long-term ventilator support and criteria for weaning and extubation are lacking. We hypothesized that many patients with SCI, even those with cervical SCI, can be successfully managed without long-term mechanical ventilation and its associated morbidity.

METHODS: Under the auspices of the Western Trauma Association Multi-Center Trials Group, a retrospective study of patients with SCI at 14 major trauma centers was conducted. Comprehensive injury, demographic, and outcome data on patients with acute SCI were compiled. The primary outcome variable was the need for mechanical ventilation at discharge. Secondary outcomes included the use of tracheostomy and development of acute lung injury and ventilator-associated pneumonia.

RESULTS: A total of 360 patients had SCI requiring mechanical ventilation. Sixteen patients were excluded for death within the first 2 days of hospitalization. Of the 344 patients included, 222 (64.5%) had cervical SCI. Notably, 62.6% of the patients with cervical SCI were ventilator free by discharge. One hundred forty-nine patients (43.3%) underwent tracheostomy, and 53.7% of them were successfully weaned from the ventilator, compared with an 85.6% success rate among those with no tracheostomy (p < 0.05). Patients who underwent tracheostomy had significantly higher rates of ventilator-associated pneumonia (61.1% vs. 20.5%, p < 0.05) and acute lung injury (12.8% vs. 3.6%, p < 0.05) and fewer ventilator-free days (1 vs. 24 p < 0.05). When controlled for injury severity, thoracic injury, and respiratory comorbidities, tracheostomy after cervical SCI was an independent predictor of ventilator dependence with an associated 14-fold higher likelihood of prolonged mechanical ventilation (odds ratio, 14.1; 95% confidence interval, 2.78-71.67; p < 0.05).

CONCLUSION: While many patients with SCI require short-term mechanical ventilation, the majority can be successfully weaned before discharge. In patients with SCI, tracheostomy is associated with major morbidity, and its use, especially among patients with cervical SCI, deserves further study.

LEVEL OF EVIDENCE: Prognostic study, level III.

Author List

Kornblith LZ, Kutcher ME, Callcut RA, Redick BJ, Hu CK, Cogbill TH, Baker CC, Shapiro ML, Burlew CC, Kaups KL, DeMoya MA, Haan JM, Koontz CH, Zolin SJ, Gordy SD, Shatz DV, Paul DB, Cohen MJ, Western Trauma Association Study Group

Author

Marc Anthony De Moya MD Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Aged, 80 and over
Airway Extubation
Female
Follow-Up Studies
Humans
Injury Severity Score
Length of Stay
Male
Middle Aged
Prognosis
Respiration, Artificial
Retrospective Studies
Spinal Cord Injuries
Survival Rate
Trauma Centers
United States
Ventilator Weaning
Young Adult