Inappropriate weaning and late onset ventilatory failure of individuals with traumatic spinal cord injury.

Eight traumatic spinal cord injured (SCI) individuals are described. Four tetraplegic patients who were weaned from initial ventilator use despite severe restrictive pulmonary syndromes experienced multiple pulmonary complications, episodes of acute respiratory failure, and 3 of the 4 required long term ventilatory support within 2 years of initial weaning. Three other SCI individuals developed chronic late-onset ventilatory failure 17, 25, and 29 years postinjury. One other tetraplegic patient was mechanically ventilated for 8.2 years post-injury despite complete recovery of autonomous ventilatory function years earlier. Of the 6 patients requiring long term ventilatory support, 4 were managed by noninvasive techniques of intermittent positive pressure ventilation (IPPV), one by negative pressure body ventilators, and one by tracheostomy IPPV. At least one and possibly as many as 5 patients were spared bronchoscopy and/or pulmonary complications by using mechanical insufflation-exsufflation (MI-E). We conclude that patients who are weaned despite having significant restrictive pulmonary syndromes are at risk for ventilatory decompensation weeks to decades after weaning. Ongoing clinical assessment, evaluation of respiratory muscle function and, at times, nocturnal blood gas analyses are warranted in the follow up of traumatic SCI individuals.