Mechanical Ventilation and Weaning Practices for Adults with Spinal Cord Injury - An International Survey

Objective: There is heterogeneity in the management of spinal cord injury (SCI) patients requiring mechanical ventilation (MV). This survey's objective was to study the current practices of ventilator management and weaning in adults with SCI. Methods: We conducted a cross-sectional, self-administered global electronic survey of providers caring for adults with SCI on MV. Recruitment was accomplished through direct E-mailing, social media posting and sharing amongst qualifying providers. Respondents were divided into acute care (AC) and rehabilitation (rehab) groups based on their work setting and specialty. Results: Overall, 137 respondents with a majority from North America (50%) were included. Assist Control mode was the most frequently reported mode (33%) in AC and the rehabilitation setting (RS). Most (72%) in AC use predicted body weight (PBW) to determine the tidal volume (VT); it varies widely in the RS. The highest VT (median [interquartile range]) reported by AC was 10 (8-10) cc/kg pbw compared to 13 (10-15) cc/kg pbw (P = 0.001) in the RS. Application of positive end-expiratory pressure and keeping the tracheostomy cuff inflated are commonly reported practices in AC, whereas there is inconsistency with these practices in the RS. Regarding factors to initiate weaning, physicians in the AC mostly relied on arterial blood gas (70%) findings, whereas in the RS, physicians relied on vital capacity (73%). Conclusion: We found significant differences in practices between "AC and RS"and "within RS,"which warrants further investigation of optimal ventilator settings and weaning practices for people with SCI.