Author(s): Chakrabarti B.; Parker R.; Plant P.K.; Manuel A.; Duffy N.; Angus R.M.; Forrest A.; Bevan M.; Ward A.; Chaudhary K.; Soni B.; Selmi F.; Lari S.
Source: Thorax; Dec 2017; vol. 72
Publication Date: Dec 2017
Publication Type(s): Conference Abstract
Available at Thorax – from BMJ Journals – NHS
Abstract:Introduction The occurrence of Spinal Cord Injury (SCI) is often complicated by the need for assisted ventilation. This study charts the weaning outcomes of mechanically ventilated SCI subjects admitted over a 10 year period to a regional Spinal Injuries unit. Methodology Acute SCI subjects with Tetraplegia admitted from April 2007-2017 to the Northwest Regional Spinal Injuries Centre (NWRSIC) were identified. Only those presenting with all 3 criteria: A) admission injury level C1-C6 b) admission ASIA score A-C and c) need for mechanical ventilation on arrival to the NWRSIC were included in the final analysis. Results The cohort consisted of 84 subjects (mean age 57 (SD 18) years; 76% male; 81 surviving to discharge). On admission, the level of injury was C1-3 in 28% (C1-3 ASIA A 20%; C1-3 ASIA B 2%; C1-3 ASIA C 6%) and C4-6 in 72% (C4-6 ASIA A 38%; C4-6 ASIA B 17%; C4-6 ASIA C 17%). On admission, 86% (72/84) were tracheostomy ventilated 24 hours/day, 12% (10/84) tracheostomy ventilated at night only and 2% (2/84) using NIV. By discharge, 13% (11/ 81) were tracheostomy ventilated 24 hours/day (including 2 Phrenic nerve paced), 13% (11/81) tracheostomy ventilated at night only, 7% (6/81) prescribed nocturnal NIV with 65% (53/81) breathing independently. Thus, when taking the entire cohort, 63% (53/81) achieved complete Ventilatory liberation, 12% (10/81) weaned to nocturnal tracheostomy ventilation only and 6% (5/81) were weaned to NIV whilst no further weaning was possible in 16% (13/81). The ability to breathe independently by discharge was found to correlate with level of injury on admission (CC 0.39; p<0.001), level of injury on discharge (CC 0.47; p<0.001) and non-significant trend with improvement in neurological function during admission (CC 0.21; p=0.06) but not age or gender. Conclusion Our data demonstrates that in a cohort of consecutive SCI patients requiring mechanical ventilation on admission to a regional Spinal injuries unit, weaning from mechanical ventilation was possible in 84% of subjects with 63% being liberated completely from Ventilatory support by discharge. The use of NIV in the SCI cohort appears to be an emergent strategy during the weaning process.