Case Report: Ventilator weaning, tracheostomy decannulation and noninvasive ventilation in an adolescent with autism spectrum disorder and new onset spinal cord injury

Introduction Spinal cord injury (SCI) is a cause of significant psychosocial stress not only to the individual with SCI but also to their family. This is compounded when an individual with a new SCI has premorbid behavioral and medical conditions. For individuals requiring long term positive pressure ventilation, transition to noninvasive ventilation (NIV) can improve the long term outcome and improve quality of life. Case presentation This case report describes a teenage boy with premorbid autism spectrum disorder who incurred an acute SCI and developed chronic respiratory failure. He was admitted to acute inpatient rehabilitation with tracheostomy and ventilator dependence. Using an interdisciplinary team approach with in vivo desensitization behavioral interventions, he was successfully weaned off mechanical ventilation, his tracheostomy tube was removed, and he was transitioned to NIV. Discussion This case describes a medically complex adolescent who was successfully transitioned to NIV through behavioral desensitization using a team approach. This is noteworthy given the magnitude of behaviors demonstrated prior to his desensitization protocol. This case demonstrates how serious behavioral barriers to NIV can be overcome using desensitization and strategic behavioral reinforcement techniques.