300 Section - Late Onset Respiratory Failure in Individuals with Chronic Spinal Cord Injury

Objectives : Cervical and thoracic spinal cord injuries can impact an individual's respiratory status related to muscular weakness and disruption to the sympathetic/parasympathetic balance. Many patients with SCI initially require ventilator support for respiratory function in the acute phase but successfully wean prior to hospital discharge. There is a small subset of patients with chronic SCI who experience respiratory failure later in life, requiring long term ventilator support. This group has limited data on the circumstances surrounding return to ventilator use.

Design: Our case series reviewed the medical records of 16 patients with chronic spinal cord injury who received care at a United States Department of Veterans Affairs Hospital. These 16 patients were initially weaned off the ventilator after injury but eventually required ventilator use at least 50% of the time.  The factors involved in their respiratory decline were evaluated, with a focus on respiratory and neurologic variables in addition to medical conditions. Objective data including pulmonary function testing was assessed.

Results: Our findings show that respiratory factors, particularly infection, were the most consistent variable, seen in all 16 cases, related to decline. Fifteen out of 16 patients had cervical injuries. Twelve of 16 patients had motor and sensory complete injuries. Changes in neurological level of injury (NLI) and American Spinal Injury Association Impairment Scale (AIS) from initial injury to the time patients resumed ventilator use were compared. Multiple patients had subtle changes in NLI, but only two patients had a major change in AIS classification, both associated with secondary medical conditions.

Conclusion: The case series suggests there is a subset of SCI patients at risk for requiring long term mechanical respiratory support often related to respiratory factors but rarely with significant neurological decline. This emphasizes the importance of consistent pulmonary hygiene in long term management of individuals with high level spinal cord injury.