Diaphragm pacing improves respiratory mechanics in acute cervical spinal cord injury.
Acute Disease
Adult
Cervical Vertebrae
Diaphragm
Electric Stimulation Therapy
Electrodes, Implanted
Female
Humans
Injury Severity Score
Intensive Care Units
Length of Stay
Linear Models
Logistic Models
Male
Middle Aged
Pneumonia, Ventilator-Associated
/ etiology
Respiration
Respiration, Artificial
/ adverse effects
Respiratory Insufficiency
/ etiology
Respiratory Mechanics
Retrospective Studies
Spinal Cord Injuries
/ complications
Young Adult
Journal
The journal of trauma and acute care surgery
ISSN: 2163-0763
Titre abrégé: J Trauma Acute Care Surg
Pays: United States
ID NLM: 101570622
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
pubmed:
30
5
2020
medline:
6
1
2021
entrez:
30
5
2020
Statut:
ppublish
Résumé
Cervical spinal cord injury (CSCI) is devastating with ventilator-associated pneumonia being a main driver of morbidity and mortality. Laparoscopic diaphragm pacing implantation (DPS) has been used for earlier liberation from mechanical ventilation. We hypothesized that DPS would improve respiratory mechanics and facilitate liberation. We performed a retrospective review of acute CSCI patients between January 2005 and May 2017. Routine demographics were collected. Patients underwent propensity score matching based on age, Injury Severity Score, ventilator days, hospital length of stay, and need for tracheostomy. Patients with complete respiratory mechanics data were analyzed and compared. Those who did not have DPS (NO DPS) had spontaneous tidal volume (Vt) recorded at time of intensive care unit admission, at day 7, and at day 14, and patients who had DPS had spontaneous Vt recorded before and after DPS. Time to ventilator liberation and changes in size of spontaneous Vt for patients while on the ventilator were analyzed. Bivariate and multivariate logistic and linear regression statistics were performed using STATA v10. Between July 2011 and May 2017, 37 patients that had DPS were matched to 34 who did not (NO DPS). Following DPS, there was a statistically significant increase in spontaneous Vt compared with NO DPS (+88 mL vs. -13 mL; 95% confidence interval, 46-131 mL vs. -78 to 51 mL, respectively; p = 0.004). Median time to liberation after DPS was significantly shorter (10 days vs. 29 days; 95% CI, 6.5-13.6 days vs. 23.1-35.3 days; p < 0.001). Liberation prior to hospital discharge was not different between the two groups. The DPS placement was found to be associated with a statistically significant decrease in days to liberation and an increase in spontaneous Vt in multivariate linear regression models. The DPS implantation in acute CSCI patients produces significant improvements in spontaneous Vt and reduces time to liberation from mechanical ventilation. Prospective comparative studies are needed to define the clinical benefits and potential cost savings of DPS implantation. Therapeutic IV.
Sections du résumé
BACKGROUND
Cervical spinal cord injury (CSCI) is devastating with ventilator-associated pneumonia being a main driver of morbidity and mortality. Laparoscopic diaphragm pacing implantation (DPS) has been used for earlier liberation from mechanical ventilation. We hypothesized that DPS would improve respiratory mechanics and facilitate liberation.
METHODS
We performed a retrospective review of acute CSCI patients between January 2005 and May 2017. Routine demographics were collected. Patients underwent propensity score matching based on age, Injury Severity Score, ventilator days, hospital length of stay, and need for tracheostomy. Patients with complete respiratory mechanics data were analyzed and compared. Those who did not have DPS (NO DPS) had spontaneous tidal volume (Vt) recorded at time of intensive care unit admission, at day 7, and at day 14, and patients who had DPS had spontaneous Vt recorded before and after DPS. Time to ventilator liberation and changes in size of spontaneous Vt for patients while on the ventilator were analyzed. Bivariate and multivariate logistic and linear regression statistics were performed using STATA v10.
RESULTS
Between July 2011 and May 2017, 37 patients that had DPS were matched to 34 who did not (NO DPS). Following DPS, there was a statistically significant increase in spontaneous Vt compared with NO DPS (+88 mL vs. -13 mL; 95% confidence interval, 46-131 mL vs. -78 to 51 mL, respectively; p = 0.004). Median time to liberation after DPS was significantly shorter (10 days vs. 29 days; 95% CI, 6.5-13.6 days vs. 23.1-35.3 days; p < 0.001). Liberation prior to hospital discharge was not different between the two groups. The DPS placement was found to be associated with a statistically significant decrease in days to liberation and an increase in spontaneous Vt in multivariate linear regression models.
CONCLUSION
The DPS implantation in acute CSCI patients produces significant improvements in spontaneous Vt and reduces time to liberation from mechanical ventilation. Prospective comparative studies are needed to define the clinical benefits and potential cost savings of DPS implantation.
LEVEL OF EVIDENCE
Therapeutic IV.
Identifiants
pubmed: 32467474
doi: 10.1097/TA.0000000000002809
pii: 01586154-202009000-00001
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
423-428Références
Center NSCIS, Center MSKT. In: Birmingham UoAa, ed. Spinal Cord Injury (SCI) Facts and Figures at a Glance. Birmingham, Alabama; 2017.
Sezer N, Akkuş S, Uğurlu FG. Chronic complications of spinal cord injury. World J Orthop. 2015;6(1):24–33.
Berlowitz DJ, Wadsworth B, Ross J. Respiratory problems and management in people with spinal cord injury. Breathe (Sheff). 2016;12(4):328–340.
Krause JS, Cao Y, DeVivo MJ, DiPiro ND. Risk and protective factors for cause-specific mortality after spinal cord injury. Arch Phys Med Rehabil. 2016;97(10):1669–1678.
Richard-Denis A, Erhmann Feldman D, Thompson C, Mac-Thiong JM. The impact of acute management on the occurrence of medical complications during the specialized spinal cord injury acute hospitalization following motor-complete cervical spinal cord injury. J Spinal Cord Med. 2018;41:388–396.
Cao Y, Li C, Newman S, Lucas J, Charlifue S, Krause JS. Posttraumatic stress disorder after spinal cord injury. Rehabil Psychol. 2017;62(2):178–185.
Liebscher T, Niedeggen A, Estel B, Seidl RO. Airway complications in traumatic lower cervical spinal cord injury: a retrospective study. J Spinal Cord Med. 2015;38(5):607–614.
Como JJ, Sutton ERH, McCunn M, Dutton RP, Johnson SB, Aarabi B, Scalea TM. Characterizing the need for mechanical ventilation following cervical spinal cord injury with neurologic deficit. J Trauma. 2005;59(4):912–916; discussion 916.
Berlowitz DJ, Brown DJ, Campbell DA, Pierce RJ. A longitudinal evaluation of sleep and breathing in the first year after cervical spinal cord injury. Arch Phys Med Rehabil. 2005;86(6):1193–1199.
Charlifue S, Apple D, Burns SP, Chen D, Cuthbert JP, Donovan WH, Lammertse DP, Meade MA, Pretz CR. Mechanical ventilation, health, and quality of life following spinal cord injury. Arch Phys Med Rehabil. 2011;92(3):457–463.
Berlowitz DJ, Tamplin J. Respiratory muscle training for cervical spinal cord injury. Cochrane Database Syst Rev. 2013;(7):CD008507.
Bach JR. Noninvasive respiratory management of high level spinal cord injury. J Spinal Cord Med. 2012;35(2):72–80.
Chervin RD, Guilleminault C. Diaphragm pacing for respiratory insufficiency. J Clin Neurophysiol. 1997;14(5):369–377.
Dalal K, DiMarco AF. Diaphragmatic pacing in spinal cord injury. Phys Med Rehabil Clin N Am. 2014;25(3):619–629, viii.
Le Pimpec-Barthes F, Gonzalez-Bermejo J, Hubsch JP, et al. Intrathoracic phrenic pacing: a 10-year experience in France. J Thorac Cardiovasc Surg. 2011;142(2):378–383.
Galeiras Vázquez R, Rascado Sedes P, Mourelo Fariña M, Montoto Marqués A, Ferreiro Velasco ME. Respiratory management in the patient with spinal cord injury. Biomed Res Int. 2013;2013:168757.
Kerwin AJ, Yorkgitis BK, Ebler DJ, Madbak FG, Hsu AT, Crandall ML. Use of diaphragm pacing in the management of acute cervical spinal cord injury. J Trauma Acute Care Surg. 2018;85(5):928–931.
Posluszny JA, Onders R, Kerwin AJ, et al. Multicenter review of diaphragm pacing in spinal cord injury: successful not only in weaning from ventilators but also in bridging to independent respiration. J Trauma Acute Care Surg. 2014;76(2):303–309; discussion 309–10.