Early insights of the COVID-19 pandemic in the Veterans' Affairs spinal cord injury and disorders population.

STUDY DESIGN: Retrospective cohort. OBJECTIVES: The primary outcome of the study was to identify patient characteristics associated with a positive COVID-19 test. The secondary outcome was to identify patient characteristics associated with mortality from COVID-19. SETTING: Veterans Health Administration (VHA) National Spinal Cord Injury and Disorders (SCI) Registry, created by the National Spinal Cord Injury and Disorders SCI Program Office in March 2020. METHODS: Data was analyzed in the form of descriptive statistics and then subsequent regression analysis was performed. RESULTS: A total of 4,562 persons with SCI were tested for COVID-19 between March and July 2020, and 290 were positive. The study found that African Americans had increased odds of testing positive for COVID-19 (OR 1.53 (1.18-2.00), p < 0.01). Increased age correlated with increased odds of mortality after testing positive for COVID-19 (1.046 (1.003-1.090)). Non-smokers had lower odds of mortality following positive COVID-19 test (0.15 (0.04-0.52)). No association was found between neurologic level of injury (NLI) and positive COVID-19 test or increased mortality. Increased Body Mass Index (BMI) did correlate with positive COVID-19 test but not increased mortality. The case fatality rate for persons with SCI and a positive test for COVID-19 was 12%. CONCLUSIONS: It is important to define the risk factors for patients with SCI to elucidate and mitigate individual and population risks. These risk factors also can play a role in determining the allocation of critical healthcare resources.

Factors Associated With Ventilator Weaning Success and Failure in People With Spinal Cord Injury in an Acute Inpatient Rehabilitation Setting: A Retrospective Study.

Objectives: To evaluate baseline characteristics, describe pulmonary outcomes, and identify weaning predictors for people with acute traumatic spinal cord injury (SCI) who are dependent on mechanical ventilation at admission to acute inpatient rehabilitation (AIR). Methods: The retrospective study was conducted at an AIR facility in the United States. It included 91 adults with acute traumatic SCI from 2015 to 2019 who were dependent on mechanical ventilation. Results: People who successfully weaned (85%) had fewer days from time of SCI to AIR admission (22 vs. 30, p = .04), higher vital capacity at admission to AIR (12 vs. 3 mL/kg predicted body weight [PBW]; p < .001), and lower (caudal) neurological injury level (p < .001) compared to those who failed weaning. The risk of pneumonia was higher in people who failed weaning compared to those who were weaned successfully (risk ratio, 5.5; 95% confidence interval [95% CI], 2.3-13). Receiver operating characteristics (ROC) curves suggest a vital capacity cutoff of 5.8 mL/kg PBW could predict weaning. The vital capacity of ≥ 5.8 mL/kg PBW is associated with 109 times higher odds (95% CI, 11-1041; p < .001) of weaning than vital capacity below that threshold. Conclusion: In this retrospective study, there was an increased risk of pneumonia in people with SCI who failed weaning at discharge from AIR. Vital capacity was a better predictor of weaning from mechanical ventilation compared to the neurological level of injury, with a cutoff of 5.8 mL/kg PBW predictive of weaning success. Further research is needed on this critical topic.

Comparing outcomes of mechanical ventilation with high vs. moderate tidal volumes in tracheostomized patients with spinal cord injury in acute inpatient rehabilitation setting: a retrospective cohort study.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: The primary objective of this study was to evaluate safety and efficacy of higher tidal volumes (HVt) compared to moderate Vt (MVt) in people with spinal cord injury (SCI) admitted to acute inpatient rehabilitation (AIR) facility on mechanical ventilation via tracheostomy. SETTING: AIR facility in the United States. METHODS: Eighty-four adults with SCI were divided into MVt group if maximum Vt received in AIR was <15 ml/kg predicted body weight (PBW) and HVt group if maximum Vt was >15 ml/kg PBW. Primary outcomes were incidence of pneumonia and composite pulmonary adverse events (pneumonia, weaning failure, or acute care transfers due to respiratory complications). Secondary outcomes were AIR preweaning days defined as time from AIR admission to beginning of weaning, weaning days defined as days from start to end of weaning, and AIR ventilator days calculated as days on ventilator from AIR admission to discharge. RESULTS: MVt was utilized in 50 patients and HVt was utilized in 34 patients. The risk of pneumonia in HVt group was 4.3 times higher [95% confidence interval (CI): 1.5-12] compared to MVt group. Odds of pulmonary adverse events in HVt group was 5.4 times higher (CI: 1.8-17) compared to MVt group. There was no difference in preweaning days, weaning days, or AIR ventilator days between the two groups. CONCLUSIONS: Our data suggest that HVt is associated with increased risk of pneumonia and higher odds of pulmonary adverse events in tracheostomized patients with SCI which warrants further investigation.