Utility of diaphragm pacing in the management of acute cervical spinal cord injury. (Dalal)

Kerwin AJ, et al. Utility of diaphragm pacing in the management of acute cervical spinal cord injury. J Trauma Acute Care Surg. 2018 Jul 5. [Epub ahead of print]

BACKGROUND: Cervical spinal cord injury (CSCI) is devastating. Respiratory failure, ventilator associated pneumonia (VAP), sepsis, and death frequently occur. Case reports of diaphragm pacing (DPS) have suggested earlier liberation from mechanical ventilation in acute CSCI patients. We hypothesized DPS implantation would decrease VAP and facilitate liberation from ventilation.

METHODS: We performed a retrospective review of acute CSCI patients managed at a single level 1 trauma center between 1/2005-5/2017. Routine demographics were collected. Patients underwent propensity matching based on age, ISS, ventilator days, hospital length of stay and need for tracheostomy. Outcome measures included hospital length of stay (HLOS), ICU length of stay (ICU LOS), ventilator days (vent days), incidence of VAP, and mortality. Bivariate and multivariate logistic and linear regression statistics were performed using STATA v10.

RESULTS: Between 7/2011-5/2017 all acute CSCI patients were evaluated for DPS implantation. 40 patients that had laparoscopic DPS implantation (DPS) were matched to 61 who did not (NO DPS). Median time to liberation after DPS implantation was 7 days. HLOS and mortality were significantly lower on bivariate analysis in DPS patients. DPS placement was not found to be associated with statistically significant differences in these outcomes on risk-adjusted multivariate models that included admission year.

CONCLUSIONS: DPS implantation in acute CSCI patients can be one part of a comprehensive critical care program to improve outcomes. However, the association of DPS with the marked improved mortality seen on bivariate analysis may be due solely to improvements in critical care throughout the study period. Further studies to define the benefits of DPS implantation are needed.

LEVEL OF EVIDENCE: Level III STUDY TYPE: Retrospective, observational study.

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