P17 Characteristics and outcomes of patients with spinal cord injury requiring mechanical ventilation at a specialist ventilation centre, 2010–2019

IntroductionPatients with spinal cord injury (SCI) often require complex ventilatory management but limited data exist on this cohort of patients. We sought to characterise the cohort of SCI patients who have received mechanical ventilation at our tertiary ventilation centre.MethodsA retrospective database evaluation of all patients referred to our centre between 2010 and 2019 with SCI and respiratory failure.Results205 adults (65% male) were evaluated. Median(IQR) age at time of injury was 43(24–66) years. 84% suffered a high cord injury (C1-C5) and 16% suffered a lower cord injury (C6 and below). Patients suffered from ASIA Grade A (70%), Grade B (16%), Grade C (10%) and Grade D (4%) injuries. 8% patients were successfully weaned from all mechanical ventilation prior to discharge. 87% of patients were established on long-term home mechanical ventilation: 50% with IMV, 37% with NIV. 4% of patients died prior to hospital discharge. 74% of patients were discharged with mechanical insufflation-exsufflation therapy. Regarding discharge destination, 67% were discharged to their home however, due to high multi-disciplinary care needs, 7% were discharged to a rehabilitation hospital and 25% were discharged to a nursing home. Time to death following injury was 5(2–19) years, with age at death of 67(56–73) years. Time to death following injury was 22(3–26) years in the NIV cohort and 7(2–12) years in the IMV cohort. Patients remained under specialist follow-up from our unit for 4(2–7) years.ConclusionThe majority of patients referred with respiratory failure following SCI who survive to discharge are successfully established on long-term ventilatory support. One quarter require care in long-term residential facilities. Three-quarters are provided with mechanical insufflation-exsufflation therapy to aid secretion clearance. Median survival is considerably longer in SCI patients than other groups requiring long-term mechanical ventilation,1 indicating a need for long-term management strategies to maximise functional capacity and improve health-related quality of life in this patient population.ReferencePatout M, Lhuillier E, Kaltsakas G, et al. Long-term survival following initiation of home non-invasive ventilation: a European study. Thorax 2020;75:965–973.