Weaning in Spinal Cord Injury ICS 12/2007. Epidemiology, Demographics and Pathophysiology of Acute Spinal Cord Injury. Lali H.S. et al SPINE 26;245; s2-s12.

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Presentation transcript:

Weaning in Spinal Cord Injury ICS 12/2007

Epidemiology, Demographics and Pathophysiology of Acute Spinal Cord Injury. Lali H.S. et al SPINE 26;245; s2-s new SCI/ Yr in UK

68 patients >C5 88% needed intubating C5-C8 60% needed intubating Velmahos gc et al American surgeon Patients Injuries C2-C8 107 required tracheostomies Harop et al Journal of neurosurgery spine 2004 Acute respiratory management

LumbarUnable to cough100-70% Low thoracic  chest wall compliance  Vital capacity High thoracic  chest wall compliance30-50%  Vital capacity poor expansion. Basal collapse C5/C6Diaphragms, Scalenes, Accessory 20% C3/C4/C5Sternomastoid and partial diaphragm Above C3Sternomastoid only5-10% Acute VC1 Year VC % 40-50% 60-70%

Weanable? C5-C8 wean in 14 days C4 and above in around 60 days »Jacson AB Groomes TE Arch Phys Med Rehab 1994:75: pts with diaphragm function weaned 3-93 days »Ooh t, Watt J Spinal Cord 1999;37:117=122

When; How; Why

All other pathology improved Lung parenchyma optimal Spasticity evident Some useful spontaneous respiratory activity Secretions manageable Awake and cooperative

When; How ; Why Bronchodilators ?High TV Ventilation (>20 ml/Kg)? 1 ?Anabolic steroids? 2 Supine 1.The effect of tidal volumes on the time to wean persons with high tetraplegia from ventilators Peterson W. et al spinal cord (4): Spungen et Al Mount Sinai Journal of Medicine may 1999

When; How ; Why Progressive ventilator free breathing Measure Vital Capacity VCTime off Vent <250 mls5 Mins -500 mls15 Mins -750 mls30 Mins mls60 Mins Measure VC Post weaning >70% pre weaning Cuff down: Speaking valve Inspiratory muscle training Southport Spinal Injury Centre

When; How ; Why Slow Weaners & Non-weaners? Cuff down ventilation Refer onwards

When; How; Why National Spinal Cord Injury Statistical Centre, University of Alabama Costs Hospitalised 1 year mortality 15%

Summary Progressive Ventilator Free Breathing Transfer to spinal injury centre Respiratory Information for Spinal Cord Injury