Spinal cord injury: outcomes of ventilatory weaning and extubation.

BACKGROUND: Spinal cord injury (SCI) carries potentially devastating respiratory implications depending on injury level. Optimal strategies for mechanical ventilation in this setting remain poorly described. We reviewed our experience of ventilatory weaning and extubation outcomes in this patient population.
METHODS: Eighty mechanically ventilated SCI patients over a 5-year period at a major Level I trauma center were assessed. Injury, clinical, and outcome data were extracted using our ICU database, chart, and registry data.
RESULTS: We identified 80 patients with SCI, classified by anatomic injury and motor functional level. There were no differences in injury severity between patients who were successfully extubated and those who failed (all p = NS). Seventy-four percent were extubated at the time of discharge; successful extubation was associated with lower level of cord injury (p = 0.001) and higher arrival Glasgow Coma Scale score (13.7 ± 2.6 vs. 10.8 ± 5.0, p = 0.021). Of extubation failures, 80% were due to pulmonary mechanical insufficiency, 22% inadequate pulmonary toilet, and 5% sedation or neurologic issues. Patients with weaning or extubation failures had longer ICU (29.9 days ± 24.5 days vs. 8.5 days ± 9.3 days; p < 0.001) and hospital stays (45.8 days ± 45.8 days vs. 26.6 days ± 23.9 days; p = 0.009), and higher rates of ventilator-associated pneumonia (83% vs. 15%, p < 0.001).
CONCLUSION: Higher level of SCI correlates strongly with failure to wean and extubate; despite this, a subset of patients with high cord injury who can be safely weaned and extubated exists. A multicenter study is warranted to specifically identify patients with high SCI who merit weaning and extubation trials.