Long-term Outlook in Quadriplegic Patients with Initial Ventilator Dependency

Traumatic spinal cord injuries frequently result in respiratory insufficiency. With intensive medical support, many of these patients live productive lives in spite of severe neurologic deficit. A ten-year review of ventilator-dependent quadriplegic patients at Craig Rehabilitation Hospital was undertaken to determine the number of patients who could be weaned from mechanical ventilation and their long-term survival rate. Ventilator dependency is defined as requiring continuous mechanical ventilatory support for 30 or more days. Of the 134 patients that were included in the study, 76 were weaned during initial hospitalization. Factors which adversely affected ability to wean include: 1) high level of neurologic injury, 2) age greater than 50 years, and 3) other associated injuries. Of the ventilator-dependent patients surveyed after leaving the hospital, survival rate at one year was 90 percent (37 of 41), 56 percent (14 of 25), at three years and 33 percent (7 of 21) at five years. We conclude that vigorous medical support and maximal efforts to wean these patients from mechanical ventilation should be undertaken to: 1) minimize the financial and emotional burden of long term institutional care, 2) reduce ventilator dependency, and 3) improve overall quality of life.