Observational study of early diaphragm pacing in cervical spinal cord injured patients to decrease mechanical ventilation during the COVID-19 pandemic

Surgery, 2023 · DOI: https://doi.org/10.1016/j.surg.2022.06.050 · Published: January 1, 2023

Spinal Cord Injury Critical Care Pulmonology

Simple Explanation

Cervical spinal cord injuries often lead to respiratory failure, requiring mechanical ventilation, a major cause of complications and death. Diaphragm pacing can reduce the need for mechanical ventilation, shorten weaning times, and improve breathing for these patients. This study examines early diaphragm pacing in patients with cervical spinal cord injuries during the COVID-19 pandemic. The goal was to decrease mechanical ventilation and allow earlier transfer to rehabilitation. The study found that early diaphragm pacing successfully weaned many patients from mechanical ventilation and reduced the need for tracheostomies, facilitating earlier rehabilitation placement.

Study Duration

2 Years

Participants

13 male subjects with traumatic cervical spinal cord injuries

Evidence Level

Not specified

Key Findings

1
Diaphragm pacing successfully weaned 82% of patients surviving past 90 days from mechanical ventilation.
2
Forty-four percent of the study group never underwent a tracheostomy.
3
Early diaphragm pacing for spinal cord injuries decreases mechanical ventilation usage and tracheostomy need.

Research Summary

This study evaluates the impact of early diaphragm pacing (DP) on weaning from mechanical ventilation (MV) and tracheostomy use in cervical spinal cord injury (SCI) patients during the COVID-19 pandemic. The results showed that early DP led to successful MV weaning in a significant proportion of patients and reduced the need for tracheostomies, enabling earlier rehabilitation. The authors conclude that early DP is a valuable strategy to decrease MV dependency and tracheostomy requirements in SCI patients, particularly during periods of high demand for ventilator resources.

Practical Implications

Clinical Practice

Early consideration of diaphragm pacing in cervical SCI patients to reduce mechanical ventilation dependence.

Resource Management

Decreased mechanical ventilation and tracheostomy needs can alleviate strain on hospital resources, especially during pandemics.

Patient Outcomes

Improved rehabilitation prospects and quality of life through reduced ventilation dependence and tracheostomy use.

Study Limitations

1
Single site report
2
No randomization of patients to DP or not DP; there was no control group.
3
There were also no female patients with SCI that were implanted during this period.

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