High tidal volume ventilation is associated with ventilator-associated pneumonia in acute cervical spinal cord injury

The Journal of Spinal Cord Medicine, 2021 · DOI: 10.1080/10790268.2020.1722936 · Published: January 1, 2021

Spinal Cord Injury Critical Care Pulmonology

Simple Explanation

Pneumonia is a major cause of death after spinal cord injury. This study investigated whether using high tidal volume ventilation (HVtV) to help patients breathe is linked to a lower risk of ventilator-associated pneumonia (VAP). The study found that HVtV was actually associated with a higher risk of VAP in acute cervical SCI patients compared to standard ventilation. This was unexpected because HVtV is sometimes used to help wean patients off ventilators. These findings suggest that using HVtV in the early stages after a cervical spinal cord injury may not be as safe or effective as previously thought and warrants further investigation.

Study Duration

2011–2018

Participants

181 adult acute cervical SCI patients

Evidence Level

Cohort study

Key Findings

1
HVtV was associated with a 1.96 relative risk of VAP development (95% credible interval 1.55–2.17) on Bayesian analysis.
2
HVtV was associated with increased rates of ventilator dependence.
3
Complete injury, high SCI level, low ISS, older age, and blunt injury mechanism were associated with increased VAP development

Research Summary

This study investigated the association between high tidal volume ventilation (HVtV) and ventilator-associated pneumonia (VAP) in patients with acute cervical spinal cord injury (SCI). The study found that HVtV was associated with an increased risk of VAP and ventilator dependence in this patient population. The authors concluded that further investigation into optimal early ventilation settings is needed for SCI patients, who are at a high risk of VAP.

Practical Implications

Rethinking Ventilation Strategies

The study challenges the widespread use of HVtV in acute cervical SCI patients, suggesting a need to re-evaluate current ventilation protocols.

Personalized Respiratory Care

Findings suggest the need for a more individualized approach to respiratory management in SCI patients, considering factors like injury severity and patient characteristics.

Further Research

Highlights the need for prospective studies to determine the optimal ventilation strategies for minimizing VAP risk and improving outcomes in acute SCI.

Study Limitations

1
Retrospective cohort design is unable to address the selection bias within the study population.
2
Other ventilation settings were not evaluated in this study
3
Patients were not stratified by SCI severity beyond complete injury

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