Mechanical ventilation weaning and extubation after spinal cord injury: A western trauma association multicenter study

Lucy Z. Kornblith, Matthew E. Kutcher, Rachael A. Callcut, Brittney J. Redick, Charles K. Hu, Thomas H. Cogbill, Christopher C. Baker, Mark L. Shapiro, Clay C. Burlew, Krista L. Kaups, Marc A. DeMoya, James M. Haan, Christopher H. Koontz, Samuel J. Zolin, Stephanie D. Gordy, David V Shatz, Doug B. Paul, Mitchell J. Cohen

Research output: Contribution to journalArticle

13 Citations (Scopus)

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 theWestern 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 G 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.

Original languageEnglish (US)
Pages (from-to)1060-1069
Number of pages10
JournalJournal of Trauma and Acute Care Surgery
Volume75
Issue number6
DOIs
StatePublished - Dec 2013

Fingerprint

Weaning
Spinal Cord Injuries
Artificial Respiration
Multicenter Studies
Wounds and Injuries
Tracheostomy
Mechanical Ventilators
Ventilator-Associated Pneumonia
Acute Lung Injury
Morbidity
Thoracic Injuries
Trauma Centers
Respiratory Insufficiency
Comorbidity
Hospitalization
Retrospective Studies
Odds Ratio
Demography
Cervical Cord
Confidence Intervals

Keywords

  • Mechanical ventilation
  • Spinal cord injury
  • Tracheostomy

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Kornblith, L. Z., Kutcher, M. E., Callcut, R. A., Redick, B. J., Hu, C. K., Cogbill, T. H., ... Cohen, M. J. (2013). Mechanical ventilation weaning and extubation after spinal cord injury: A western trauma association multicenter study. Journal of Trauma and Acute Care Surgery, 75(6), 1060-1069. https://doi.org/10.1097/TA.0b013e3182a74a5b

Mechanical ventilation weaning and extubation after spinal cord injury : A western trauma association multicenter study. / Kornblith, Lucy Z.; Kutcher, Matthew E.; Callcut, Rachael A.; Redick, Brittney J.; Hu, Charles K.; Cogbill, Thomas H.; Baker, Christopher C.; Shapiro, Mark L.; Burlew, Clay C.; Kaups, Krista L.; DeMoya, Marc A.; Haan, James M.; Koontz, Christopher H.; Zolin, Samuel J.; Gordy, Stephanie D.; Shatz, David V; Paul, Doug B.; Cohen, Mitchell J.

In: Journal of Trauma and Acute Care Surgery, Vol. 75, No. 6, 12.2013, p. 1060-1069.

Research output: Contribution to journalArticle

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 2013, 'Mechanical ventilation weaning and extubation after spinal cord injury: A western trauma association multicenter study', Journal of Trauma and Acute Care Surgery, vol. 75, no. 6, pp. 1060-1069. https://doi.org/10.1097/TA.0b013e3182a74a5b
Kornblith, Lucy Z. ; Kutcher, Matthew E. ; Callcut, Rachael A. ; Redick, Brittney J. ; Hu, Charles K. ; Cogbill, Thomas H. ; Baker, Christopher C. ; Shapiro, Mark L. ; Burlew, Clay C. ; Kaups, Krista L. ; DeMoya, Marc A. ; Haan, James M. ; Koontz, Christopher H. ; Zolin, Samuel J. ; Gordy, Stephanie D. ; Shatz, David V ; Paul, Doug B. ; Cohen, Mitchell J. / Mechanical ventilation weaning and extubation after spinal cord injury : A western trauma association multicenter study. In: Journal of Trauma and Acute Care Surgery. 2013 ; Vol. 75, No. 6. pp. 1060-1069.
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T1 - Mechanical ventilation weaning and extubation after spinal cord injury

T2 - A western trauma association multicenter study

AU - Kornblith, Lucy Z.

AU - Kutcher, Matthew E.

AU - Callcut, Rachael A.

AU - Redick, Brittney J.

AU - Hu, Charles K.

AU - Cogbill, Thomas H.

AU - Baker, Christopher C.

AU - Shapiro, Mark L.

AU - Burlew, Clay C.

AU - Kaups, Krista L.

AU - DeMoya, Marc A.

AU - Haan, James M.

AU - Koontz, Christopher H.

AU - Zolin, Samuel J.

AU - Gordy, Stephanie D.

AU - Shatz, David V

AU - Paul, Doug B.

AU - Cohen, Mitchell J.

PY - 2013/12

Y1 - 2013/12

N2 - 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 theWestern 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 G 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.

AB - 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 theWestern 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 G 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.

KW - Mechanical ventilation

KW - Spinal cord injury

KW - Tracheostomy

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