Long-term Outlook in Quadriplegic Patients with Initial Ventilator Dependency

Wicks, Allan B.; Menter, Robert R.

doi:10.1378/chest.90.3.406

Cited by 97 publications

(41 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Pulmonary complications are the leading cause of death in this population, with most respiratory death attributed to pneumonia. 8,9 In the last 15 years, there has been an increase in the incidence of patients with high-level quadriplegia (C1-C4) and represent approximately one-third of the patients with spinal cord injury, and 50% of them have a complete lesion. 6,8 Most of them require mechanical ventilation either temporary or permanently.…”

Section: Introductionmentioning

confidence: 99%

Ventilator-associated pneumonia in long-term ventilator-assisted individuals

et al. 2010

View full text Add to dashboard Cite

Background: Information on the characteristics of pneumonia in long-term ventilator-assisted individuals is scarce. We evaluate the incidence, risk factors and outcome of ventilator-associated pneumonia (VAP) in a large series of chronically ventilated patients. Methods: All patients assisted in a chronic ventilator-dependent unit were prospectively followed up for the development of VAP. Patients with a new and persistent lung infiltrate and a purulent tracheal aspirate were suspected to have VAP. Pneumonia was considered microbiologically confirmed in the presence of (1) a positive blood culture and/or (2) X10 5 CFU ml À1 in quantitative bacterial culture of tracheal aspirates or X10 3 CFU ml À1 in quantitative mini-bronchoalveolar lavage cultures. Results: In total, 100 consecutive long-term ventilated individuals with spinal cord injury (mean age 49 years) were prospectively followed up. The length of mechanical ventilation before admission in the unit was 54±37 days, and the follow-up after admission was 119±127 days. There were 32 episodes of VAP in 27 patients (1.74 episodes per 1000 days of mechanical ventilation). By logistic regression analysis, hypoalbuminaemia (P ¼ 0.03), administration of antacids (P ¼ 0.002) and length of mechanical ventilation (P ¼ 0.05) were independent risk factors for VAP. The most frequently isolated organisms were Pseudomonas aeruginosa (62%), methicillin-resistant Staphylococcus aureus (25%) and Acinetobacter baumannii (15%); 9 (28%) episodes were polymicrobial. Antimicrobial treatment, including monotherapy in 66%, was successful in most patients. Only three patients (11%) died in relation to VAP. Conclusions: Patients on long-term ventilation are at significant risk for the development of VAP, but the mortality is low.

show abstract

Section: Introductionmentioning

confidence: 99%

Ventilator-associated pneumonia in long-term ventilator-assisted individuals

et al. 2010

View full text Add to dashboard Cite

show abstract

“…Several studies have reported on the long-term survival of persons with ventilator-dependent spinal cord injury (SCI) (1)(2)(3)(4)(5). In the most comprehensive of these, DeVivo and Ivie (5) calculated substantially reduced life expectancies for these individuals compared with persons in the general population of comparable age, sex, and race.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Survival of Persons Ventilator Dependent After Spinal Cord Injury

Shavelle¹,

DeVivo

Strauss³

et al. 2006

The Journal of Spinal Cord Medicine

View full text Add to dashboard Cite

Background/Objective: Identify factors related to long-term survival, and quantify their effect on mortality and life expectancy.Setting: Model spinal cord injury systems of care across the United States.Study Design: Survival analysis of persons with traumatic spinal cord injury who are ventilator dependent at discharge from inpatient rehabilitation and who survive at least 1 year after injury.Methods: Logistic regression analysis on a data set of 1,986 person-years occurring among 319 individuals injured from 1973 through 2003. Results:The key factors related to long-term survival were age, time since injury, neurologic level, and degree of completeness of injury. The life expectancies were modestly lower than previous estimates. Pneumonia and other respiratory conditions remain the leading cause of death but account for only 31% of deaths of known causes.Conclusions: Whereas previous research has suggested a dramatic improvement in survival over the last few decades in this population, this is only the case during the critical first few years after injury. There was no evidence for such a trend in the subsequent period.

show abstract

“…Individuals with complete tetraplegia at the C3 and C4 neurological levels were selected because they represent a level at which ventilator free breathing is di cult but theoretically possible. 2,5 Individuals with these levels of injury were identi®ed by the presence of functional bilateral trapezius muscle strength (manual muscle test grades of`fair' or better 19 ), and non-functional distal musculature (grade`poor' or less 19 ), including both biceps and deltoids.…”

Section: Methodsmentioning

confidence: 99%

“…Not only has survival among both groups increased dramatically over the past several decades, 1 but most ventilator dependent tetraplegics ± as many as 83% in one report ± now ultimately wean from the mechanical ventilator and regain the ability to breathe on their own. 2,3 However, such respiratory-compromised tetraplegia survivors frequently present an unparalleled weaning challenge. The length of time required for them to become ventilator-free can be protracted ± as long as 14 months in one report, 4 up to 8 years in another.…”

Section: Introductionmentioning

confidence: 99%

The effect of tidal volumes on the time to wean persons with high tetraplegia from ventilators

et al. 1999

View full text Add to dashboard Cite

Study design: Retrospective review of patient medical records comparing the outcomes of two groups of individuals with high-level (C3-4) tetraplegia ± those with high-volume and those with low-volume mechanical ventilation. Objectives: To determine if higher volume mechanical ventilation contributes to faster weaning from the ventilator with fewer complications in individuals with ventilator dependent high-level tetraplegia. Setting: A Model Spinal Injury Center, located in Colorado, USA, which treats patients referred from throughout the Rocky Mountain region as well as other states. Methods: The medical records of 42 individuals with ventilator dependent C3-4 tetraplegia, admitted consecutively to the Rocky Mountain Regional Spinal Injury System between 1983 and 1993, were reviewed. All had required full-time mechanical ventilation upon admission, but had successfully weaned by discharge. They were divided into two groups that di ered with respect to the ventilator tidal volumes used during their treatment and weaning: a large volume group (420 mls/kg of body weight) and a smaller volume group (520 mls/kg of body weight). Results: Though the two groups were equivalent in neurological level and completeness, muscular function, initial spontaneous vital capacity, the weaning method used (T-piece), and ®nal spontaneous vital capacity, those in the large tidal volume group successfully weaned an average of 21 days faster than the lower tidal volume group (37.6 days vs 58.7 days, P=0.02). They also had signi®cantly less atelectasis (P=0.01) than the lower tidal volume group. Conclusion: This research suggests that the use of higher ventilator tidal volumes may speed up the weaning process and lessen respiratory complications. Because of the potential for this to decrease the length and cost of the rehabilitation programs for persons with high-level tetraplegia, further large-scale research is needed to verify these single-center ®ndings.

show abstract

Long-term Outlook in Quadriplegic Patients with Initial Ventilator Dependency

Cited by 97 publications

References 23 publications

Ventilator-associated pneumonia in long-term ventilator-assisted individuals

Ventilator-associated pneumonia in long-term ventilator-assisted individuals

Long-Term Survival of Persons Ventilator Dependent After Spinal Cord Injury

The effect of tidal volumes on the time to wean persons with high tetraplegia from ventilators

Contact Info

Product

Resources

About