by Annia F. Schreiber, Jacopo Garlasco, Fernando Vieira, Yie
Hui Lau, Dekel Stavi, David Lightfoot, Andrea Rigamonti, Karen Burns, Jan O.
Friedrich, Jeffrey M. Singh and Laurent J. Brochard
Annals of
Intensive Care volume 11,
Article number: 149 (2021)
Background
Prolonged need for mechanical ventilation greatly impacts
life expectancy of patients after spinal cord injury (SCI). Weaning outcomes
have never been systematically assessed. In this systematic review and
meta-analysis, we aimed to investigate the probability of weaning success,
duration of mechanical ventilation, mortality, and their predictors in
mechanically ventilated patients with SCI.
Methods
We searched six databases from inception until August 2021
for randomized-controlled trials and observational studies enrolling adult
patients (≥ 16 years) with SCI from any cause requiring mechanical
ventilation. Titles and abstracts were screened independently by two reviewers.
Full texts of the identified articles were then assessed for eligibility. Data
were extracted independently and in duplicate by pairs of authors, using a
standardized data collection form. Synthetic results are reported as
meta-analytic means and proportions, based on random effects models.
Results
Thirty-nine studies (14,637 patients, mean age 43) were
selected. Cervical lesions were predominant (12,717 patients had cervical
lesions only, 1843 in association with other levels’ lesions). Twenty-five
studies were conducted in intensive care units (ICUs), 14 in rehabilitative
settings.
In ICU, the mean time from injury to hospitalization was
8 h [95% CI 7–9], mean duration of mechanical ventilation 27 days
[20–34], probability of weaning success 63% [45–78] and mortality 8% [5–11].
Patients hospitalized in rehabilitation centres had a greater number of
high-level lesions (C3 or above), were at 40 days [29–51] from injury and
were ventilated for a mean of 97 days [65–128]; 82% [70–90] of them were
successfully weaned, while mortality was 1% [0–19].
Conclusions
Although our study highlights the lack of uniform definition
of weaning success, of clear factors associated with weaning outcomes, and of
high-level evidence to guide optimal weaning in patients with SCI, it shows
that around two-thirds of mechanically ventilated patients can be weaned in ICU
after SCI. A substantial gain in weaning success can be obtained during
rehabilitation, with additional duration of stay but minimal increase in
mortality. The study is registered with PROSPERO (CRD42020156788).
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