An intermediate respiratory care unit for spinal cord-injured patients. A retrospective study

Romero-Ganuza, Javier; García-Forcada, Ángel; Vargas, Eduardo Raupp de; Gambarrutta, Claudia

doi:10.1038/sc.2015.10

Cited by 7 publications

(5 citation statements)

References 19 publications

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“…After a long-standing dependency on the ventilator for 4 months, he was successfully weaned 39 days after the introduction of an automated weaning tool. The length of the weaning process is comparable to those reported in a case series of conventional weaning for spinal cord-injured patients in the settings of an intermediate respiratory care unit [ 5 ] and rehabilitation clinic [ 6 ]. The recovery of our patient’s expiratory V T from 150 to 350 mL after the auto-weaning process may be due to reinnervation of the diaphragm, stabilization of the chest wall, and reduction of abdominal compliance [ 1 ].…”

Section: Discussionsupporting

confidence: 55%

“…Most of the patients with a complete injury at or above the C5 cord level will require mechanical ventilation and a tracheostomy. A substantial number of these patients will recover spontaneous ventilation after following an adequate protocol of weaning from the respirator [ 6 ]. The weaning process conventionally uses SBT, which gradually increases the spontaneous breathing time manually.…”

Section: Discussionmentioning

confidence: 99%

“…The weaning process conventionally uses SBT, which gradually increases the spontaneous breathing time manually. This process, however, takes place in the ICU or in the spinal cord unit [ 5 , 6 ]. The medical staff in our ward is composed of two neurologists and one internist.…”

Section: Discussionmentioning

confidence: 99%

“…The patient was preoptimized by means of pulmonary care and rehabilitation before the weaning process [ 7 ]. After respiratory optimization, his V T of 150 mL suggested an incomplete paralysis of the diaphragm and the potential to be weaned from mechanical ventilation [ 5 , 6 ]. After a long-standing dependency on the ventilator for 4 months, he was successfully weaned 39 days after the introduction of an automated weaning tool.…”

Section: Discussionmentioning

confidence: 99%

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Weaning from long-term mechanical ventilation utilizing closed-loop ventilation mode (IntelliVent®-ASV®) in a patient with spinal cord injury

Shimizu

Nakajima

Yamazaki

et al. 2018

Spinal Cord Ser Cases

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IntroductionCervical spinal cord injury with the C3 neurological level may cause respiratory failure and require long-term mechanical ventilation. Conventional weaning of spontaneous breathing trials is difficult to perform outside of intensive care or spinal cord units.Case presentationAn 80-year-old man presented with total tetraplegia and restrictive respiratory failure that required assisted ventilation after a falling accident. Cervical spine magnetic resonance imaging showed cervical cord compression that was worst at the C3–C4 intervertebral level. He experienced unexpected cardiac arrest during the conventional weaning process of trials of intermittent spontaneous breathing in the intensive care unit. The automated weaning protocol utilizing a closed-loop ventilation mode (IntelliVent®-ASV®) was introduced 131 days after injury in our ward for chronically ill patients. The patient was successfully weaned 39 days after the introduction of the weaning protocol.DiscussionAn automated weaning protocol utilizing a closed-loop ventilation mode could be an optional procedure in patients with cervical cord injury on long-term mechanical ventilation, even in a ward for chronically ill patients where sufficient staff is not available. The efficacy and safety, and the cost-effectiveness of the procedure should be examined in larger spinal cord units.

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Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Weaning from long-term mechanical ventilation utilizing closed-loop ventilation mode (IntelliVent®-ASV®) in a patient with spinal cord injury

Shimizu

Nakajima

Yamazaki

et al. 2018

Spinal Cord Ser Cases

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“…[6,7] Ventilation (intubation, tracheotomy, and tracheostomy) is always conducted instantly [8] after RC (which includes pneumonia, atelectasis, and hemothorax) occurs to improve the situation and avoid further aggravation; the intermediate respiratory care unit (IRCI) could solve this problem. [9] According to the aforementioned, early detection and timely treatment, particularly, are more important; the efficiency of predictable risk factors must be evaluated in real-time and side-by-side.…”

Section: Introductionmentioning

confidence: 99%

Risk factors and the surgery affection of respiratory complication and its mortality after acute traumatic cervical spinal cord injury

2017

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The aim of this study is to estimate the risk factors of both respiratory complication (RC) and mortality after acute traumatic cervical spinal cord injury (TCSCI). Between July 2005 and July 2015, in 181 patients (142 males and 39 females; mean age 41.0 years) with acute TCSCI, we compared the difference and odds ratio in RC group (n = 73) with that of non-RC group (n = 108), and also death group (n = 15) and survival group (n = 166). We collected injury-related information after half a year of injury, which is as follows: the causes of injury, time of surgery, ICU (intensive care unit) days, ventilator days, ASIA (American Spinal Injury Association) classification, neurological injury, CIPS (Clinical Pulmonary Infection Score), and BMI (body mass index). Besides these, we gathered the general information such as age, gender, smoking history, and use of steroids. The study compared perioperative parameters; surgery-related and instrumentation- and graft-related complication rates; clinical parameters; patient satisfaction; and radiologic parameters. Variations like gender (odds ratio [OR] = 1.269, 95% confidence interval [CI] [0.609-2.646]), smoking history (OR = 2.902, 95% CI [1.564-5.385]), AIS grade (grade A) (OR = 6.439, 95% CI [3.334-12.434]), neurological level (C1-C4) (OR = 2.714, 95% CI [1.458-5.066]), and steroid use (OR = 2.983, 95% CI [1.276-6.969]) have a facilitated effect on RC. When we estimated surgery-related affection, only the time of surgery and anterior approach compared with posterior has significant difference in RC (P < .05). Between death and survival group, the aspect of age, non-surgical, CPIS, AIS grade, and BMI have statistically significant difference. Survival analysis reveals significant difference in aforementioned groups. In patients suffering from acute TCSCI, those who are old, have long smoking history, complete spinal cord injury, C1-C4, high CPIS, and fat have high incidence of RC and mortality.

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Evolución respiratoria y motora en lesión medular cervical. Diecisiete años de experiencia en un centro de desvinculación de asistencia ventilatoria mecánica: un estudio observacional

Escobar¹,

Navarro

Rositi³

et al. 2020

Rehabilitación

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An intermediate respiratory care unit for spinal cord-injured patients. A retrospective study

Cited by 7 publications

References 19 publications

Weaning from long-term mechanical ventilation utilizing closed-loop ventilation mode (IntelliVent®-ASV®) in a patient with spinal cord injury

Weaning from long-term mechanical ventilation utilizing closed-loop ventilation mode (IntelliVent®-ASV®) in a patient with spinal cord injury

Risk factors and the surgery affection of respiratory complication and its mortality after acute traumatic cervical spinal cord injury

Evolución respiratoria y motora en lesión medular cervical. Diecisiete años de experiencia en un centro de desvinculación de asistencia ventilatoria mecánica: un estudio observacional

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