Spinal cord · 2026
35 years of long-term invasive mechanical ventilation in high tetraplegic patients due to chronic respiratory failure - comparative results of pressure- (PCV) and volume-controlled ventilation (VCV) in the out-of-hospital setting.
СтатьяСравнительное исследованиеРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
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Hirschfeld Sven, Kowald Birgitt, Thietje Roland, Rudolph Merle
Аннотация
STUDY DESIGN: Retrospective, randomised controlled, monocentric, longitudinal cohort study.
OBJECTIVES: To evaluate data from outpatient clinical practice to determine whether the chosen ventilation mode (PCV or VCV) affects the rate of pneumonia, post-discharge survival and mortality, with the aim of ensuring appropriate long-term ventilation outside the hospital for tetraplegic patients on invasive long-term ventilation.
SETTING: Data collection and patient examinations were conducted in a german clinical setting (BG Trauma Hospital Hamburg), while long-term ventilation and outpatient intensive care were provided exclusively outside the hospital setting in the patients' home environment in Germany.
METHODS: Over a period of 35 years (01.01.1985 - 31.12.2019), two patient cohorts (Level of lesion C2-C4) permanently invasive ventilated either pressure-controlled (PCV n = 21) or volume-controlled (VCV n = 21) due to complete diaphragm paralysis were examined at regular intervals of 1-2 years. A group of patients with spinal cord injury (n = 83), level of lesion C4-C6 AIS A, that had not received mechanical ventilation at any point prior to the study proper word was randomised and used as a control group.
RESULTS: Neither PCV nor VCV have significant influence on the pneumonia rate, the out-of-hospital survival and the mortality. As expected, there were significant differences between the ventilated group and the non-ventilated control group. Within the ventilated group, both pneumonia rates and mortality were higher and survival times significantly shorter.
CONCLUSION: It has been confirmed for the out-of-hospital setting that the selected ventilation mode has no influence on the pneumonia rate, out-of-hospital survival time and mortality. In addition, with regard to the risks of invasive long-term ventilation, the key finding of this study is that a pressure- or volume-controlled ventilation mode can be selected without weighing additional medical risks and that this mode can also be changed during long-term ventilation.
SPONSORSHIP: This study was not funded by a sponsor.
OBJECTIVES: To evaluate data from outpatient clinical practice to determine whether the chosen ventilation mode (PCV or VCV) affects the rate of pneumonia, post-discharge survival and mortality, with the aim of ensuring appropriate long-term ventilation outside the hospital for tetraplegic patients on invasive long-term ventilation.
SETTING: Data collection and patient examinations were conducted in a german clinical setting (BG Trauma Hospital Hamburg), while long-term ventilation and outpatient intensive care were provided exclusively outside the hospital setting in the patients' home environment in Germany.
METHODS: Over a period of 35 years (01.01.1985 - 31.12.2019), two patient cohorts (Level of lesion C2-C4) permanently invasive ventilated either pressure-controlled (PCV n = 21) or volume-controlled (VCV n = 21) due to complete diaphragm paralysis were examined at regular intervals of 1-2 years. A group of patients with spinal cord injury (n = 83), level of lesion C4-C6 AIS A, that had not received mechanical ventilation at any point prior to the study proper word was randomised and used as a control group.
RESULTS: Neither PCV nor VCV have significant influence on the pneumonia rate, the out-of-hospital survival and the mortality. As expected, there were significant differences between the ventilated group and the non-ventilated control group. Within the ventilated group, both pneumonia rates and mortality were higher and survival times significantly shorter.
CONCLUSION: It has been confirmed for the out-of-hospital setting that the selected ventilation mode has no influence on the pneumonia rate, out-of-hospital survival time and mortality. In addition, with regard to the risks of invasive long-term ventilation, the key finding of this study is that a pressure- or volume-controlled ventilation mode can be selected without weighing additional medical risks and that this mode can also be changed during long-term ventilation.
SPONSORSHIP: This study was not funded by a sponsor.