A multimodal respiratory weaning intervention for adult critical care patients mechanically ventilated with cervical spinal cord injury: a quality improvement project.

Abstract

Study design: Quality improvement project.

Objectives: To review outcomes for adult patients admitted to ICU with a cervical spinal cord injury (SCI) requiring mechanical ventilation (MV); develop a multimodal respiratory weaning intervention (MRWI); and assess its impact on patient outcomes.

Setting: A Major Trauma Centre in the UK.

Methods: A retrospective service evaluation was conducted in 2020 to establish patient characteristics and outcomes. The findings of this, along with a literature review were used to develop a MRWI, comprising: a readiness to wean proforma; an adaptation of the Respiratory Information in Spinal Cord Injuries (RISCI) guidelines; and a weekly SCI ward round. The MRWI was implemented, with a second prospective service evaluation performed between January 2022 and January 2025. The primary outcome was the level of MV weaning at ICU discharge; secondary outcomes included compliance with assessments of diaphragm excursion with lung thoracic ultrasound (LUS) and respiratory mechanics.

Results: The pre- and post-MRWI service evaluations included N = 12 and N = 33 patients, respectively. The MRWI was associated with significantly higher compliance with assessments of LUS (82% [27/33] vs. 25% [3/12], p < 0.001) and respiratory mechanics (e.g. maximal inspiratory pressure: 48% [16/33] vs. 0% [0/12], p = 0.003). There was a non-significant tendency for higher rates of liberation from MV in ICU after the MRWI (79% [23/29] vs. 50% [6/12], p = 0.067); this was statistically significant for the C2-C4 SCI subgroup (78% [14/18] vs. 20% [1/5], p = 0.032).

Conclusions: This QIP provides some evidence that implementing a MRWI may improve weaning outcomes in cervical SCIs admitted to ICU.