Pneumonia as a modifiable risk factor of mechanical ventilation in cervical spinal cord injuries

Abstract

RATIONALE: Spinal cord injuries greatly impact morbidity and mortality. High cervical injury level often leads to the need of definitive airway. Whether pneumonia is a modifiable risk factor for mechanical ventilation (MV) and prolonged MV in this population is unclear in the literature.OBJECTIVES: The objective of this study was to determine whether pneumonia is an independent risk factor for MV and prolonged MV.METHODS: We conducted a retrospective chart review of consecutive cervical spinal cord injuries admitted to the Hôpital Sacré-Coeur de Montreal in the last 10 years. Eligible patients were identified using the local spinal trauma registry. We recorded data related to the mechanism and type of injury, patient demographics, duration of MV, respiratory complications, intensive care unit and hospital length of stay, and patients’ outcomes. Univariate logistic regression and multivariate logistic regression were performed to determine statistically significant predictors of MV and prolonged MV.MEASUREMENTS AND MAIN RESULTS: Between 2005 and 2014, 348 consecutive cervical injured patients were included. In the multivariate analysis, the presence of pneumonia (odds ratio (OR) 7.42; 3.02–18.27) was independently associated with the need for intubation and the presence of ventilator-associated pneumonia (OR 5.16; 2.00–13.27), was significantly associated with prolonged MV. The median duration of MV was 32.0 days (interquartile range [IQR] = 48.0) in patients with ventilator acquired pneumonia (VAP) compared to 7.0 days (IQR =20.0) in patients without VAP (p < 0.01).CONCLUSIONS: In conclusion, respiratory infection in the cervical spinal injured population is an important factor leading to intubation and prolonged MV.