Risk factors for prolonged duration of mechanical ventilation in acute traumatic tetraplegic patients--a retrospective cohort study

Abstract

Purpose: Respiratory complications constitute an important determinant of length of stay in tetraplegic patients. In a population of tetraplegic patients, we investigated the factors involved in the duration of mechanical ventilation (MV) and whether the duration of MV was associated with the long-term neurologic status.

Material and methods: In a retrospective study in 3 intensive care units (ICUs) (January 2001 to December 2009), consecutive patients (≥ 18 years) hospitalized for acute (≤ 24 hours) traumatic tetraplegia were included in the study. Patients with severe brain injury or who died in the first 48 hours were excluded. The primary outcome was the duration of MV. The secondary outcomes were the American Spinal Injury Association (ASIA) motor score on ICU discharge and at 1 year.

Results: A total of 164 consecutive adult patients with tetraplegia were analyzed. Median (interquartile range) ASIA motor scores were 15 (6-26) on admission, 22 (9-40) on ICU discharge (n = 145 survivors), and 37 (10-80) at 1 year (n = 52 complete follow-up). The median duration of MV was 11 (2-26) days. In multivariate analysis, MV duration increased with pneumonia (P < .0001), atelectasis (P = .0042), and tracheotomy (P < .0001). In exploratory analysis, an increased duration of MV was the only factor associated in multivariate analysis with a low ASIA motor score on ICU discharge (P = .0201) and at 1 year (P = .0003).

Conclusions: Prevention of pneumonia and atelectasis is critical for the reduction of MV in tetraplegic patients. Prolonged MV was independently associated with poor neurologic status.

Keywords: Atelectasis; Cervical spine injury/tetraplegia; Mechanical ventilation/complications; Neurological recovery; Pneumonia.