Peterson et al. (1999) USA Cohort N=42 | Population: Age range: 15-60 yr; Gender: male=37, female=5; Level of injury: C3-C4; Severity of injury: complete. Intervention: Patients either received high tidal volume (HTV) (20mL/kg) or low tidal volume (LTV) (15.5mL/kg) for progressive ventilator-free breathing. Outcome Measures: incidence of atelectasis, lung pressure measured through centimetre of water (cmH20). Chronicity: Mean duration of injury at time of hospital admission=56 days (LTV group) and 49 days (HTV group). | 1. Patients who received LTV had significantly more atelectasis compared to patients who received HTV (p=0.01). 2. Patients who received HTV had significantly higher cmH20 compared to patients who received LTV (p<0.001). |
Kornblith et al. (2014) USA Case Control N=344 | Population: Mean age: 43 yr; Gender: male=275, female=69; Level of injury: cervical to lumbar; Severity of injury: complete=69, incomplete=275. Intervention: Patients either had a tracheostomy or did not. Of those requiring a tracheostomy, patients either experienced an early tracheostomy or a late tracheostomy. In addition, patients were either mechanically ventilated at discharge or were not. Outcome Measures: The following retrospectively: instances of prolonged mechanical ventilation, ventilator-associated pneumonia (VAP), acute lung injury (ALI), acute respiratory distress syndrome (ARDS), duration in intensive care unit (ICU), duration in hospital, number of ventilator-free days, extubation attempts, injury severity score (ISS). Chronicity: Time since injury not specified. Average number of hospital days=20. | 1. Patients who received a tracheostomy had higher rates of VAP (p<0.05), higher rates of ALI (p<0.01), spent significantly more days in ICU (p<0.05) and hospital (p<0.05), and had fewer ventilator-free days (p<0.05) compared to patients who did not receive a tracheostomy. 2. There were no significant differences with regards to death (p>0.05) between patients who received a tracheostomy and patients who did not. 3. Patients who had a late tracheostomy had higher rates of VAP (p<0.05), ALI (p<0.05), and ARDS (p<0.05) compared to patients who had an early tracheostomy. 4. Patients who required mechanical ventilation at discharge had a higher ISS (p<0.05), significantly higher rates of VAP (p<0.05) and ALI (p<0.05), and longer ICU (p<0.05) and hospital stays (p<0.05) compared to patients who did not require mechanical ventilation at discharge. |
Nakashima et al. (2013) Japan Case Control N=164 | Population: Mean age: 45 yr; Gender: male=143, female=21; Level of injury: cervical; Severity of injury: complete=58, incomplete=106; AIS A-E. Intervention: Patients either received a tracheostomy or did not. Of those who did, they were either successfully decannulated or not. Outcome Measures: Proportion of patients who received a tracheostomy, proportion of patients who were successfully decannulated, level of injury, ASIA score. Chronicity: Mean time interval from injury to tracheostomy=5 days; Mean time interval from tracheostomy to decannulation=46 days. Time since injury not specified for patients who did not receive tracheostomy. | 1. 15.2% (25/164) received a tracheostomy, 84% (21/25) of these were successfully decannulated. 2. Patients who received a tracheostomy had a history of smoking significantly more than patients who did not receive a tracheostomy (p=0.02). 3. Patients with a complete injury from C1–C4 (p=0.01) or C5–C7 (p<0.001) received a tracheostomy significantly more than patients with an incomplete injury at any level. 4. All patients with C5–7 ASIA A were successfully decannulated. Patients with C1–4 ASIA A were significantly more common in the non-decannulation group compared to patients with other injury severities and injury levels (p<0.05). |
Call et al. (2011) USA Case Control N=87 | Population: Mean age: 39 yr; Gender: male=70, female=17; Level of injury: cervical to lumbar; Severity of injury: not specified. Intervention: Patients were either discharged on ventilator support, tracheostomy collar, or natural airway. Of patients who were extubated, they were either successful on their first try, experienced 1 failure, or experienced multiple failures. Outcome Measures: The following during hospital stay: attempt at extubation, number of ventilator-free days, incidence of mechanical ventilation at discharge. The following at discharge: length of intensive care unit (ICU) stay, incidence of ventilator-associated pneumonia (VAP). The following after extubation: length of ICU stay, number of ventilator-free days, length of hospital stay, incidence of VAP. Chronicity: Time since injury not specified. The mean time to tracheostomy=12 days. The mean length of hospital stay=33 days. | Outcome of patients by degree of injury severity: 1. Patients with cervical injuries and complete motor loss had a higher rate of no attempt at extubation (p=0.041), significantly fewer ventilator-free days (p=0.003), and higher incidence of mechanical ventilation at discharge (p=0.014) compared to patients without complete motor loss. Outcomes of patients at hospital discharge: 2. Patients who were discharged on positive pressure ventilation had longer ICU stays compared to extubated patients (p<0.001). Patients discharged on a tracheostomy collar had longer ICU stays than those who were extubated or decannulated (p<0.001). 3. The incidence of VAP was significantly higher in patients requiring mechanical ventilation (p<0.001) and those discharged on tracheostomy collar (p=0.001) compared to patients who were discharged with a natural airway. Outcome of patients who underwent extubation: 4. Of patients in whom extubation was attempted, those who extubated successfully on the first attempt had significant shorter ICU stays (p<0.001), more ventilator-free days (p<0.001), and shorter hospital stays (p=0.009) compared with patients who failed one or more weaning or extubation attempts. 5. Patients failing one or more attempts had a significantly higher incidence of VAP (p<0.001) compared to patients who were successful on their first attempt. |
Peterson et al. (1994) USA Case Control N=52 | Population: Mean age: 39 yr; Gender: male=80%, female=20%; Level of injury: cervical to lumbar; Severity of injury: not specified. Intervention: Patients were either discharged on ventilator support, tracheostomy collar, or natural airway. Of patients who were extubated, they were either successful on their first try, experienced 1 failure, or experienced multiple failures. Outcome Measures: The following during hospital stay: attempt at extubation, number of ventilator-free days, incidence of mechanical ventilation at discharge. The following at discharge: length of intensive care unit (ICU) stay, incidence of ventilator-associated pneumonia (VAP). The following after extubation: length of ICU stay, number of ventilator-free days, length of hospital stay, incidence of VAP. Chronicity: Time since injury not specified. The mean time to tracheostomy=12 days. The mean length of hospital stay=33 days. | 1. At one month post injury, significantly more patients who received PVFB had weaned compared to patients who received IMV (p=0.01). 2. The overall ventilator weaning success rate for PVFB was significantly higher than the success rate of IMV (p=0.02). Outcome of patients by degree of injury severity: 3. Patients with cervical injuries and complete motor loss had a higher rate of no attempt at extubation (p=0.041), significantly fewer ventilator-free days (p=0.003), and higher incidence of mechanical ventilation at discharge (p=0.014) compared to patients without complete motor loss. Outcomes of patients at hospital discharge: 4 Patients who were discharged on positive pressure ventilation had longer ICU stays compared to extubated patients (p<0.001). Patients discharged on a tracheostomy collar had longer ICU stays than those who were extubated or decannulated (p<0.001). 5 The incidence of VAP was significantly higher in patients requiring mechanical ventilation (p<0.001) and those discharged on tracheostomy collar (p=0.001) compared to patients who were discharged with a natural airway. Outcome of patients who underwent extubation: 6. Of patients in whom extubation was attempted, those who extubated successfully on the first attempt had significant shorter ICU stays (p<0.001), more ventilator-free days (p<0.001), and shorter hospital stays (p=0.009) compared with patients who failed one or more weaning or extubation attempts. 7. Patients failing one or more attempts had a significantly higher incidence of VAP (p<0.001) compared to patients who were successful on their first attempt. |