Respirator-dependent quadriplegics: problems during the weaning period

During a two-year period we admitted 13 respirator-dependent quadriplegic patients to the spinal cord injury service at Wood VAMC for weaning from a mechanical ventilator, and rehabilitation. The patients were sent to the Spinal Cord Injury Center because initial weaning attempts from the respirator at other medical centers were unsuccessful. We successfully weaned them from the respirator, and at the time of discharge, only two patients required an indwelling tracheostomy tube for suction. The time required for weaning off the respirator varied from two days to 14 months. Most of the patients were discharged and many of them could independently perform the activities of daily living. We conclude that are four main factors which influence the successful weaning of dependent quadriplegics from the mechanical ventilator: alleviation of patient's anxiety and depression; family support; close working relationship between staff; prevention of complications such as pneumonia and urinary tract infections.