Pulmonary Rehabilitation: Pulmonary Rehabilitation |

Successful Tracheostomy Decannulation After Motor Complete Cervical Spinal Cord Injury FREE TO VIEW

DongHyun Kim, MD; Seong-Woong Kang, MD; Won-Ah Choi, MD; Mi-Ri Suh, MD
Author and Funding Information

Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea (the Republic of)

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1122A. doi:10.1016/j.chest.2016.08.1231
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SESSION TITLE: Pulmonary Rehabilitation

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Respiratory dysfunction is a major cause of morbidity and mortality in spinal cord injury (SCI), which causes impairment of respiratory muscles, reduced vital capacity, inefficient cough, and impaired mechanics of ventilation. Patients with cervical SCI (CSCI) are at increased risk of tracheostomy although the majority can be managed noninvasively without empiric tracheostomy. We aimed to analyze the successful tracheostomy decannulation or extubation in motor complete CSCI patients.

METHODS: Motor complete CSCI patients who had received invasive acute phase respiratory management, and succeeded in either decannulation or extubation at pulmonary rehabilitation center of Gangnam Severance hospital became candidates of this study. Retrospective review was conducted on the transitions of the respiratory status.

RESULTS: Sixty-two motor complete CSCI patients (M:55, F:7) were identified. Traumatic causes of SCI accounted for 93.5% (n=58), and mean age at SCI onset was 47.6 ± 15.8 yrs. Sixty patients (96.8%) had undergone tracheostomy and the other 2 received endotracheal intubation during acute phase management. All patients succeeded in decannulation/extubation after employing mechanically assisted coughing (MAC) and noninvasive mechanical ventilation (NIV). Mean time since tracheostomy to decannulation was 7.0 ± 14.5 months. Of the 60 tracheostomized patients, 12 succeeded in decannulation without applying long-term NIV, 31 switched to continuous NIV after decannulation. Fifteen patients totally weaned off from ventilators after NIV. Two patients who once succeeded in decannulation was re-tracheostomized due to unexpected emergencies. For the 31 patients with continuous NIV, mean hours of daily need for ventilatory support had reduced from initial 15.3 ± 8.0 hrs to 5.7 ± 5.7 hrs at final follow ups.

CONCLUSIONS: Motor complete CSCI patients even with high neurologic level of injury can benefit from NIV and aggressive use of MAC. Undesirable tracheostomy can be avoided by employing the noninvasive respiratory management.

CLINICAL IMPLICATIONS: With the use of noninvasive respiratory management such as NIV and MAC, undesirable empiric tracheostomy can be minimized even to high CSCI patients.

DISCLOSURE: The following authors have nothing to disclose: DongHyun Kim, Seong-Woong Kang, Won-Ah Choi, Mi-Ri Suh

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