Context/Objective

Pneumonia is the leading cause of death after acute spinal cord injury (SCI). High tidal volume ventilation (HVtV) is used in SCI rehabilitation centers to overcome hypoventilation while weaning patients from the ventilator. Our objective was to determine if HVtV in the acute post-injury period in SCI patients is associated with lower incidence of ventilator-associated pneumonia (VAP) when compared to patients receiving standard tidal volume ventilation.

Design

Cohort study.

Setting

Red Duke Trauma Institute, University of Texas Health Science Center at Houston, TX, USA.

Participants

Adult Acute Cervical SCI Patients, 2011–2018.

Interventions

HVtV.

Outcome measures

VAP, ventilator dependence at discharge, in-hospital mortality.

Results

Of 181 patients, 85 (47%) developed VAP. HVtV was utilized in 22 (12%) patients. Demographics, apart from age, were similar between patients who received HVtV and standard ventilation; patients were younger in the HVtV group. VAP developed in 68% of patients receiving HVtV and in 44% receiving standard tidal volumes (P = 0.06). After adjustment, HVtV was associated with a 1.96 relative risk of VAP development (95% credible interval 1.55–2.17) on Bayesian analysis. These results correlate with a >99% posterior probability that HVtV is associated with increased VAP when compared to standard tidal volumes. HVtV was also associated with increased rates of ventilator dependence.

Conclusions

While limited by sample size and selection bias, our data revealed an association between HVtV and increased VAP. Further investigation into optimal early ventilation settings is needed for SCI patients, who are at a high risk of VAP.

中文翻译：

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高潮气量通气与急性颈脊髓损伤的呼吸机相关性肺炎有关

背景/目标

肺炎是急性脊髓损伤 (SCI) 后死亡的主要原因。SCI 康复中心使用高潮气量通气 (HVtV) 来克服通气不足，同时使患者脱离呼吸机。我们的目标是确定与接受标准潮气量通气的患者相比，SCI 患者急性损伤后时期的 HVtV 是否与较低的呼吸机相关性肺炎 (VAP) 发生率相关。

设计

队列研究。

环境

美国德克萨斯州休斯顿德克萨斯大学健康科学中心红杜克创伤研究所。

参与者

成人急性宫颈 SCI 患者，2011-2018。

干预措施

高压电视。

结果措施

VAP、出院时对呼吸机的依赖、住院死亡率。

结果

在 181 名患者中，85 名（47%）发生了 VAP。22 名 (12%) 患者使用了 HVtV。除年龄外，接受 HVtV 和标准通气的患者的人口统计学特征相似；HVtV 组的患者更年轻。68% 的接受 HVtV 的患者和 44% 的接受标准潮气量的患者出现 VAP（P  = 0.06）。调整后，在贝叶斯分析中，HVtV 与 1.96 的 VAP 发展相对风险（95% 可信区间 1.55-2.17）相关。与标准潮气量相比，这些结果与 >99% 的后验概率相关，即 HVtV 与增加的 VAP 相关。HVtV 也与呼吸机依赖率增加有关。

结论

虽然受到样本量和选择偏差的限制，但我们的数据揭示了 HVtV 与增加的 VAP 之间的关联。对于 VAP 高风险的 SCI 患者，需要进一步研究最佳早期通气设置。