Implementation of a respiratory rehabilitation protocol: weaning from the ventilator and tracheostomy in difficult-to-wean patients with spinal cord injury

Abstract

A multifaceted, multidisciplinary respiratory management program can change the process of care used for difficult-to-wean patients with SCI. Implications for rehabilitation Findings from this study indicate the significance of a multidimensional evaluation of any reversible factors for prolonged MV- and/or TT-dependent SCI patients. Thus, rehabilitation specialists should take this into consideration and should provide the appropriate amount of time to these patients. The proposed protocol of respiratory rehabilitation for MV- and/or TT-dependent SCI patients shows promising results in terms of changing the care used for these patients. Successful implementation of a respiratory rehabilitation and weaning protocol is dependent on careful planning and detailed communication between the rehabilitation specialist and intensivist during the respiratory rehabilitation process. Because many of the so-called difficult- or impossible-to-wean patients were successfully weaned from MV and TT in the PMR clinic, the need for such an outlet for countries without specialized centers is supported.

The role of polysomnography in decannulation of children with brain and spinal cord injuries

“…There have been only a small number of studies regarding decannulation protocols specific to pediatric patients with brain and spinal cord disorders undergoing inpatient rehabilitation, none of which utilize PSG. In contrast, our results support the use of PSG in this patient population given the association of these disorders with the development of neuromuscular weakness and decreased tone.…”

“…Decannulation success rates varied between 54% and 79.5% [6][7][8] and successful decannulation was found to be associated with AHI, 6-8 percent of total sleep time with oxygen saturation less than 90%, 6 oxygen nadir, 6 and maximal end tidal CO 2 . 8 There have been only a small number of studies regarding decannulation protocols specific to pediatric patients with brain 9 and spinal cord disorders 19,20 undergoing inpatient rehabilitation, none of which utilize PSG. In contrast, our results support the use of PSG in this patient population given the association of these disorders with the development of neuromuscular weakness and decreased tone.…”

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

“…Respiratory complications are the leading cause of morbidity and mortality in the short and long term after cervical spinal cord injury [ 5 ]. Most of the patients with a complete injury at or above the C5 cord level will require mechanical ventilation and a tracheostomy.…”

“…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.…”

“…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.…”