Post-Acute Ventilator Weaning and Discharge Outcomes in Individuals With Cervical Spinal Cord Injury

Cervical spinal cord injury (CSCI) often results in respiratory muscle weakness, requiring prolonged mechanical ventilation and tracheostomy. However, the frequency and timing of ventilator-weaning milestones after acute hospitalization are not well described. This study assessed the rates and timing of daytime ventilator weaning, liberation from invasive ventilator support, and decannulation among adults with CSCI managed under a standardized weaning protocol at a rehabilitation center, and the associations of weaning milestones with discharge disposition.

We retrospectively analyzed data from adults with CSCI admitted to the University of Utah Craig H. Neilsen Rehabilitation Hospital between 2015 and 2022. All subjects required continuous mechanical ventilation via tracheostomy upon admission and underwent a standardized ventilator weaning protocol. We tracked the time to reach key ventilator-weaning milestones-daytime wean, liberation from invasive mechanical ventilation, and decannulation-and categorized discharge destinations based on required respiratory support intensity. Predictors of milestone achievement and discharge outcomes were assessed using Fine-Gray competing-risk and proportional odds logistic regression models.

Among 39 subjects, 76% were weaned from daytime ventilator support (median day 20), 62% were liberated from invasive ventilatory support (median day 23), and 48% were decannulated (median day 36) by discharge. Subjects with lower-level injuries (C5-C8) were more likely to achieve further weaning and decannulation compared with those with high-level injuries (C1-C4) (odds ratio [OR] 5.54 [1.51-20.38]). Increasing age was associated with discharge to more intensive care settings (OR 0.68 per decade [0.48-0.95]). Decannulated subjects had higher odds of being discharged home (OR 22.84 [2.84-183.57]). No significant differences in weaning status based on discharge disposition were observed.

Most subjects with CSCI initially on continuous mechanical ventilation achieved partial or full ventilatory independence during rehabilitation, although these milestones were often reached several weeks into their stay.