1. Weaning in Spinal Cord Injury ICS 12/2007

2. Epidemiology, Demographics and Pathophysiology of Acute Spinal Cord Injury. Lali H.S. et al SPINE 26;245; s2-s12 800-1000 new SCI/ Yr in UK

3. 68 patients >C5 88% needed intubating C5-C8 60% needed intubating Velmahos gc et al American surgeon 2003 156 Patients Injuries C2-C8 107 required tracheostomies Harop et al Journal of neurosurgery spine 2004 Acute respiratory management

5. LumbarUnable to cough100-70% Low thoracic  chest wall compliance  Vital capacity High thoracic  chest wall compliance30-50%  Vital capacity poor expansion. Basal collapse C5/C6Diaphragms, Scalenes, Accessory 20% C3/C4/C5Sternomastoid and partial diaphragm Above C3Sternomastoid only5-10% Acute VC1 Year VC 100-70% 40-50% 60-70%

6. Weanable? C5-C8 wean in 14 days C4 and above in around 60 days »Jacson AB Groomes TE Arch Phys Med Rehab 1994:75:270-275 73 pts with diaphragm function weaned 3-93 days »Ooh t, Watt J Spinal Cord 1999;37:117=122

7. When; How; Why

8. All other pathology improved Lung parenchyma optimal Spasticity evident Some useful spontaneous respiratory activity Secretions manageable Awake and cooperative

9. When; How ; Why Bronchodilators ?High TV Ventilation (>20 ml/Kg)? 1 ?Anabolic steroids? 2 Supine 1.The effect of tidal volumes on the time to wean persons with high tetraplegia from ventilators Peterson W. et al spinal cord 1999 37(4):284-288 2. Spungen et Al Mount Sinai Journal of Medicine may 1999

10. When; How ; Why Progressive ventilator free breathing Measure Vital Capacity VCTime off Vent <250 mls5 Mins -500 mls15 Mins -750 mls30 Mins -1000 mls60 Mins Measure VC Post weaning >70% pre weaning Cuff down: Speaking valve Inspiratory muscle training Southport Spinal Injury Centre

11. When; How ; Why Slow Weaners & Non-weaners? Cuff down ventilation Refer onwards

12. When; How; Why National Spinal Cord Injury Statistical Centre, University of Alabama Costs Hospitalised 1 year mortality 15%

13. Summary Progressive Ventilator Free Breathing Transfer to spinal injury centre www.risci.org.uk Respiratory Information for Spinal Cord Injury