Using an evidence-based protocol to guide rehabilitation and weaning of ventilator-dependent cervical spinal cord injury patients

Abstract

Abstract-An evidence-based clinical protocol was developed to improve ventilatory muscle strength and endurance of ventilator-dependent cervical spinal cord injury (SCI) patients. The goal was to help these patients discontinue mechanical ventilation. The protocol, based on findings from other studies in the literature, consisted of pretraining optimization, as well as progressive resistance and endurance training. Following the protocol, mean maximal inspiratory pressure for low tetraplegic patients improved 75 percent, mean maximal expiratory pressure improved 71 percent, mean vital capacity increased 59 percent, mean on-vent endurance time increased 91.6 percent, and mean off-vent breathing time increased 76.7 percent. Both high and low tetraplegic patients achieved gains in inspiratory and expiratory muscle strength, vital capacity, onvent endurance, and off-vent breathing times. High tetraplegic patients improved their ability to spontaneously ventilate for short periods in case of accidental disconnection from the ventilator, while low tetraplegic patients were able to discontinue mechanical ventilation, which was the desired clinical outcome for this preliminary study.

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

“…11 Furthermore, the success rate is even better if we eliminate from this figure the patients in whom weaning is impossible because of the degree of severity of SCI (29 out of 35, 82.8%). The weaning process in our patients is slow because of the need of retraining and strengthening of the undamaged respiratory muscles (in our series, average was 47.3 days, median 25, versus 29 days of average in patients with neuromuscular diseases 10 or 12.5-15 days in unselected patients), 16,17 and it is similar to other series of SCI patients (26.6-56 days).…”

“…Some experiences in SCI patients have shown promising results. [9][10][11][12] With this study, we have tried to evaluate the outcome of the IRCU of our hospital during 2.5 years, with the goal of establishing its efficacy in the treatment and follow-up of patients with respiratory failure due to SCI.…”

Spinal Synaptic Enhancement with Acute Intermittent Hypoxia Improves Respiratory Function after Chronic Cervical Spinal Cord Injury

“…Intermittent hypoxia has interesting implications as a possible therapeutic approach to humans with chronic cervical SCI. For example, after SCI, it may be that respiratory function along residual neural pathways can be enhanced after a relatively innocuous respiratory maneuver, and that physical therapy aimed at strengthening respiratory muscle performance (Gutierrez et al, 2003) may be facilitated by previous administration of intermittent hypoxia to strengthen residual synaptic pathways.…”

A comparison of high vs standard tidal volumes in ventilator weaning for individuals with sub-acute spinal cord injuries: a site-specific randomized clinical trial

“…We chose to have both groups adhere to a protocol because it was previously shown that having a designated protocol allows people with SCI to gradually improve endurance and strength, which leads to better outcomes. 20 We did not achieve the anticipated enrollment due to lower than expected admissions of individuals meeting the study criteria, and this decreased the statistical power of the study. This study cannot be considered a definitive trial on the efficacy of one Vt strategy or the other but does provide important information on the duration of weaning and the safety of using higher Vts in patients with subacute SCI.…”