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

Abstract

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.

Pulmonary Rehabilitation throughout the Weaning from Mechanical Ventilation for Complete Cervical Spinal Cord Injury: A Case Report

“…Different from common ventilated patients who developed ventilator-induced diaphragm dysfunction and lead to weaning difficulties, SCI patients mainly suffered from motor impairment and prolonged mechanical ventilation further impaired diaphragm function. Shimizu et al reported a case where a closed-loop ventilation mode helped weaning from mechanical ventilation in an SCI patient [11]. However, it was a choice due to shortness in medical staffs.…”

Closed-loop ventilation

“…INTELLiVENT-ASV has been shown to be safe and sometimes more efficient for weaning cardiac-surgery patients from mechanical ventilation [31 ▪ ,32]. It was also used to wean patients with spinal-cord injury [56].…”