Abstract
IntroductionCervical spinal cord injury with the C3 neurological level may cause respiratory failure and require long-term mechanical ventilation. Conventional weaning of spontaneous breathing trials is difficult to perform outside of intensive care or spinal cord units.Case presentationAn 80-year-old man presented with total tetraplegia and restrictive respiratory failure that required assisted ventilation after a falling accident. Cervical spine magnetic resonance imaging showed cervical cord compression that was worst at the C3–C4 intervertebral level. He experienced unexpected cardiac arrest during the conventional weaning process of trials of intermittent spontaneous breathing in the intensive care unit. The automated weaning protocol utilizing a closed-loop ventilation mode (IntelliVent®-ASV®) was introduced 131 days after injury in our ward for chronically ill patients. The patient was successfully weaned 39 days after the introduction of the weaning protocol.DiscussionAn automated weaning protocol utilizing a closed-loop ventilation mode could be an optional procedure in patients with cervical cord injury on long-term mechanical ventilation, even in a ward for chronically ill patients where sufficient staff is not available. The efficacy and safety, and the cost-effectiveness of the procedure should be examined in larger spinal cord units.
Highlights
Cervical spinal cord injury with the C3 neurological level may cause respiratory failure and require long-term mechanical ventilation
Weaning from mechanical ventilation in these patients may take a longer time and be exertive compared to patients with acute respiratory failure in intensive care units (ICU)
Cervical spine magnetic resonance imaging showed cervical cord compression that was worse at the C3–C4 intervertebral level, and an intramedullary high signal at C3 and C4 vertebral levels, and the patient was managed conservatively
Summary
Respiratory complications are the leading cause of morbidity and mortality in the short and long term after cervical spinal cord injury [5]. In such circumstances, an ordinary weaning process that requires frequent observations of patients during SBT is elaborative. The patient was preoptimized by means of pulmonary care and rehabilitation before the weaning process [7] After respiratory optimization, his VT of 150 mL suggested an incomplete paralysis of the diaphragm and the potential to be weaned from mechanical ventilation [5, 6]. Accompanied by pulmonary care and rehabilitation, an automated weaning protocol utilizing the closed-loop ventilation mode could be an optional procedure in patients with a cervical cord injury on long-term mechanical ventilation, even in a ward in which sufficient monitoring staff is not available. The efficacy and safety, and the cost-effectiveness of the procedure should be examined in larger spinal cord units
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