Evolución respiratoria y motora en lesión medular cervical. Diecisiete años de experiencia en un centro de desvinculación de asistencia ventilatoria mecánica: un estudio observacional / Respiratory and physical recovery in cervical spinal cord injury. Seventeen years’ experience in a weaning and rehabilitation center: An observational study

Introducción y objetivos: La lesión medular (LM) es una entidad devastadora que genera importante discapacidad. La evolución motora y la respiratoria tienen impacto humano y social. Se analizaron aspectos demográficos, evolución respiratoria, motora y el equipamiento necesario al alta en un centro de desvinculación de ventilación mecánica y rehabilitación (CDVMR). Materiales y métodos: Estudio observacional, descriptivo y retrospectivo de historias clínicas entre enero de 2002 y diciembre de 2018. Se incluyeron pacientes con LM cervical, traqueostomía y ventilación mecánica invasiva. Se obtuvieron: capacidad vital forzada (sedestación, decúbito supino), presiones inspiratorias y espiratorias máximas, ASIA y Spinal Cord Independence MeasureIII (SCIMIII). Resultados: De 1.603 pacientes, el 3,1% tenían LM y 28 reunieron el criterio de inclusión. Los niveles más frecuentes (17/28) fueron C4-C5, 21/28 tenían ASIAA, 19 no cambiaron el grado de lesión ni la puntuación en el SCIMIII. Fueron desvinculados 22/28 pacientes y 15/28 fueron decanulados. Veinticuatro pacientes alcanzaron el alta domiciliaria. El mayor cambio en el SCIMIII fue en el componente5 del dominio respiración y manejo esfinteriano, relacionado exclusivamente con la desvinculación del ventilador y la presencia de traqueostomía. Al alta, 23/24 pacientes fueron equipados con dispositivos de asistencia respiratoria y motora. Conclusiones: Las LM representan un bajo porcentaje de admisión a CDVMR, y casi la totalidad fueron de origen traumático. La mayoría de los pacientes con ASIAA permanecieron en el mismo grado de severidad. La evolución respiratoria tuvo mayores cambios, mientras que la motora presentó cambios marginales. Al alta, la mayoría de nuestros pacientes necesitaron equipamiento motor y respiratorio.(AU)

Introduction and objectives: Spinal cord injury (SCI) is a devastating entity that generates substantial disability. The outcome of respiratory and motor features has an impact in human and social well-being. We analyzed demographic characteristics, motor and respiratory outcomes, and determined equipment needs at discharge in a weaning and rehabilitation center. Material and method: Observational, descriptive and retrospective study of medical records between January 2002 and December 2018. Tracheostomised cervical SCI patients with invasive mechanical ventilation were included. Forced vital capacity (upright and supine), maximal inspiratory and expiratory pressures, ASIA and Spinal Cord Independence MeasureIII (SCIMIII) were obtained. Results: Of 1603 patients, 3.5% had SCI, and 28 met the inclusion criteria. The most frequent level of injury was C4-C5 (17/28), 21/28 had ASIAA classification, and 19 showed no change in either the ASIA or the SCIM score. In all, 22/28 patients were weaned, while 15/28 were decannulated. Twenty four patients were discharged to home. The most relevant change in SCIMIII was in the 5th component of respiration and sphincter subscale, related to weaning and tracheostomy. At discharge, 23/24 patients needed both respiratory and motor aids. Conclusions: The admission rate of SCI patients was low in our weaning and rehabilitation center, with almost all being admitted for traumatic causes. Severity remained unchanged in most ASIAA patients. Respiratory recovery was more clinically significant than recovery of motor function. Upon discharge, most of our patients had to be equipped with both respiratory and motor aids.(AU)

[Respiratory and physical recovery in cervical spinal cord injury. Seventeen years' experience in a weaning and rehabilitation center: An observational study]. / Evolución respiratoria y motora en lesión medular cervical. Diecisiete años de experiencia en un centro de desvinculación de asistencia ventilatoria mecánica: un estudio observacional.

INTRODUCTION AND OBJECTIVES: Spinal cord injury (SCI) is a devastating entity that generates substantial disability. The outcome of respiratory and motor features has an impact in human and social well-being. We analyzed demographic characteristics, motor and respiratory outcomes, and determined equipment needs at discharge in a weaning and rehabilitation center. MATERIAL AND METHOD: Observational, descriptive and retrospective study of medical records between January 2002 and December 2018. Tracheostomised cervical SCI patients with invasive mechanical ventilation were included. Forced vital capacity (upright and supine), maximal inspiratory and expiratory pressures, ASIA and Spinal Cord Independence MeasureIII (SCIMIII) were obtained. RESULTS: Of 1603 patients, 3.5% had SCI, and 28 met the inclusion criteria. The most frequent level of injury was C4-C5 (17/28), 21/28 had ASIAA classification, and 19 showed no change in either the ASIA or the SCIM score. In all, 22/28 patients were weaned, while 15/28 were decannulated. Twenty four patients were discharged to home. The most relevant change in SCIMIII was in the 5th component of respiration and sphincter subscale, related to weaning and tracheostomy. At discharge, 23/24 patients needed both respiratory and motor aids. CONCLUSIONS: The admission rate of SCI patients was low in our weaning and rehabilitation center, with almost all being admitted for traumatic causes. Severity remained unchanged in most ASIAA patients. Respiratory recovery was more clinically significant than recovery of motor function. Upon discharge, most of our patients had to be equipped with both respiratory and motor aids.

Respiratory muscle strength and state of consciousness values measured prior to the decannulation in different levels of complexity. A longitudinal prospective case series study. / Valores de fuerza muscular respiratoria y estado de conciencia medido previo a la decanulación en diferentes niveles de complejidad. Estudio de serie de casos longitudinal y prospectiva.

OBJECTIVE: To describe the variables related to effective cough capacity and the state of consciousness measured prior to decannulation and compare their measured values between the different areas of care such as the Intensive Care Unit (ICU), General ward and Mechanical Ventilation Weaning and Rehabilitation Centers (MVWRC). Secondarily analyze the evolution of patients once decannulated. DESIGN: Case series, longitudinal and prospective. SCOPE: Multicentric 31 ICUs (polyvalent) and 5 MVWRC. PATIENTS: Tracheostomized adults prior to decannulation. MEASUREMENTS: Maximum expiratory pressure, peak expiratory flow coughed (PEFC), Glasgow Coma Scale (GCS). RESULTS: Two hundred and seven decannulated patients, 124 (60%) in ICU, 59 (28%) General ward and 24 (12%) in MVWRC. The PEFC presented differences between the patients (ICU 110 - 190 l/min versus MVWRC 167.5 - 232.5 l/min, p <.01). The GCS was different between General ward (9 -15) versus ICU (10-15) and MVWRC (12-15); p <.01 and p <.01, respectively. There were differences in the days of hospitalization (p <.01), days with tracheostomy (<0.01) and the number of patients referred at home (p =.02) between the different scenarios. CONCLUSION: There are differences in the values of PEFC and GCS observed when decannulating between different areas. A considerable number of patients are decannulated with values of PEFC and maximum expiratory pressure below the suggested cut-off points as predictors of failure in the literature. No patient in our series was decanulated with an GCS <8, this reflects the importance that the treating team gives to the state of consciousness prior to decannulation.