ArticleSpinal cord2025
A multimodal respiratory weaning intervention for adult critical care patients mechanically ventilated with cervical spinal cord injury: a quality improvement project.
Article in Spinal cord, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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4 authors.
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Abstract
STUDY
designQuality improvement project.
objectivesTo review outcomes for adult patients admitted to ICU with a cervical spinal cord injury (SCI) requiring mechanical ventilation (MV); develop a multimodal respiratory weaning intervention (MRWI); and assess its impact on patient outcomes.
settingA Major Trauma Centre in the UK.
methodsA retrospective service evaluation was conducted in 2020 to establish patient characteristics and outcomes. The findings of this, along with a literature review were used to develop a MRWI, comprising: a readiness to wean proforma; an adaptation of the Respiratory Information in Spinal Cord Injuries (RISCI) guidelines; and a weekly SCI ward round. The MRWI was implemented, with a second prospective service evaluation performed between January 2022 and January 2025. The primary outcome was the level of MV weaning at ICU discharge; secondary outcomes included compliance with assessments of diaphragm excursion with lung thoracic ultrasound (LUS) and respiratory mechanics.
resultsThe pre- and post-MRWI service evaluations included N = 12 and N = 33 patients, respectively. The MRWI was associated with significantly higher compliance with assessments of LUS (82% [27/33] vs. 25% [3/12], p < 0.001) and respiratory mechanics (e.g. maximal inspiratory pressure: 48% [16/33] vs. 0% [0/12], p = 0.003). There was a non-significant tendency for higher rates of liberation from MV in ICU after the MRWI (79% [23/29] vs. 50% [6/12], p = 0.067); this was statistically significant for the C2-C4 SCI subgroup (78% [14/18] vs. 20% [1/5], p = 0.032).
conclusionsThis QIP provides some evidence that implementing a MRWI may improve weaning outcomes in cervical SCIs admitted to ICU.
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