A comparison of high vs standard tidal volumes in ventilator weaning for individuals with sub-acute spinal cord injuries: a site-specific randomized clinical trial.

Abstract

STUDY DESIGN:

Prospective, randomized, controlled parallel group trial with single-blinded data analysis.

OBJECTIVES:

To determine the safety and efficacy of higher (20 ml kg(-1) ideal body weight (IBW)) vs standard (10 ml kg(-1) IBW) tidal volumes (Vt) for patients with sub-acute traumatic tetraplegia during ventilator weaning using a 14-day (minimum) weaning protocol.

SETTING:

United States regional spinal cord injury treatment center.

METHODS:

Thirty-three ventilator requiring inpatients were randomized to either the higher (Group 1) or the standard (Group 2) Vt protocol. Initially, all patients were ventilated at 10 ml kg(-1) IBW Vt and 5 cm H(2)O [corrected] of PEEP for 72 h. For Group 1, Vt was raised 100 ml kg(-1) until reaching target Vt of 20 ml kg(-1) IBW. Group 2 was maintained at Vt of 10 ml kg(-1) IBW. Plateau pressures were kept at or below 30 cm H(2)O. [corrected]. Safety outcomes included incidence of adverse events.

RESULTS:

Because of smaller than expected enrollment, evaluation of efficacy was not possible. Therefore, we report the safety outcomes of 33 study participants. The 16 patients in Group 1 and 17 patients in Group 2 were demographically similar at baseline, except for age. The average age was 39.3 years in Group 1 and 27.2 years in Group 2, (P=0.002). There was no difference in median days to wean: 14.5 days in Group 1 and 14 days in Group 2. The incidence of adverse pulmonary events was similar between groups.

CONCLUSION:

Higher tidal volumes can be safely utilized during weaning of patients with tetraplegia from mechanical ventilation using a 14-day weaning protocol.

• Authors: J J Fenton, M L Warner, D Lammertse, S Charlifue, L Martinez, A Dannels-McClure, S Kreider, C Pretz
• Journal: Spinal cord (Spinal Cord) Vol. 54 Issue 3 Pg. 234-8 (Mar 2016) ISSN: 1476-5624 [Electronic] England
• PMID: 26369888 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, U.S. Gov't, Non-P.H.S.)

Topics

• Adult
• Cervical Vertebrae (injuries)
• Female
• Humans
• Male
• Middle Aged
• Spinal Cord Injuries (complications, physiopathology)
• Tidal Volume (physiology)
• Ventilator Weaning (methods)