Respiratory Workshop:
Tracks
Thalie
| Tuesday, November 5, 2019 |
| 4:20 PM - 5:50 PM |
| Thalie |
Overview
Mechanical Ventilation in Spinal Cord Injury Leads to Increased Morbidity and Mortality
Speaker
Dr Raymond Onders
Chief Of Surgery
University Hospitals Cleveland Medical Center
Mechanical Ventilation in Spinal Cord Injury Leads to Increased Morbidity and Mortality: The Worldwide Interdisciplinary Experience in Addressing This Problem
Abstract
Three learning objectives:
1. Review acute and chronic management of tracheostomy mechanical ventilation in SCI
2. Discuss how mechanical ventilation and diaphragm pacing impacts SCI rehabilitation
3. Describe the use of early implantation of diaphragm pacing
Participant Level: Material is suitable for any level.
Target Audience: Any healthcare team (physician, respiratory therapy, nursing, physical therapy and consumers) member who may be involved in the care of ventilated patients.
ABSTRACT
Introduction: Dr. Onders General Surgeon, United States (15 minutes)
Spinal Cord Injury (SCI) can lead to catastrophic respiratory failure requiring invasive mechanical ventilation (MV). During the initial hospitalization there is a 60% ventilator associated pneumonia (VAP) rate. MV drastically increases the mortality rate of patients of all ages. According to the National Spinal Cord Injury Statistics, there has been a drastic decline in survival from 2010 to 2018 for a 20 year old SCI on MV from 17.1 years to 11.3 years. MV frequently leads to a delay in rehabilitation which subsequently decreases quality of life.
This workshop intends to review basic respiratory mechanics in SCI that lead to mechanical ventilation, the problems associated with mechanical ventilation and the role of diaphragm pacing in this population. Recent reports demonstrate that DP is associated with a significant decrease in short term mortality of 15% to 3% (Kerwin et al, 2018) and improved median long term survival to 22.2 years (Onders et al, 2018).
Chronic Mechanical Ventilation in Spinal Cord Injury- The Dutch Experience: Dr. Wijkstra Pulmonologist, Netherlands (20 minutes)
Spinal cord injured patients, even those with low thoracic injuries have some degree of respiratory compromise. When levels are in the high cervical region, mechanical ventilation is often needed and becomes chronic in 30% of the population. Despite chronic mechanical ventilation, sputum immobilization is frequently present and pneumonia will develop. Management of chronic mechanical ventilation will be discussed. Optimizing the care of patients on chronic mechanical can decrease the complications. Review of management techniques will be highlighted.
Chronic Respiratory Failure and its effect on Spinal Cord Rehabilitation: Dr. Benito Rehabilitation Specialist, Spain (20 minutes)
It is widely understood SCI patients progress optimally when transitioned from ICU after initial injury to SCI rehabilitation. For patients dependent on tracheostomy mechanical ventilation, rehabilitation efforts can be thwarted. First, there are minimal facilities willing and able to accommodate a ventilated patient. Second, accommodating the actual ventilator and tubing can interfere with activities. Management of respiratory failure while optimizing rehabilitation will be addressed. The transition to diaphragm pacing as a ventilatory mode in a rehabilitation hospital will also be highlighted.
Temporary Diaphragm Pacing During the Acute Injury Phase: Dr. Landscheid Trauma Surgeon, Germany (20 minutes)
Ventilator Induced Diaphragm Dysfunction rapidly occurs in patients post traumatic injury while on MV. New mechanisms to shorten the initial ICU stay can include the use of temporary diaphragm pacing to maintain diaphragm muscle which will be reviewed. Early direct visualization of the diaphragm can also identify non-weanable patients. An acute trauma hospital experience from initial ventilator management and assessment for diaphragm pacing will be discussed.
Fifteen minutes will be left for questions and discussion.
1. Review acute and chronic management of tracheostomy mechanical ventilation in SCI
2. Discuss how mechanical ventilation and diaphragm pacing impacts SCI rehabilitation
3. Describe the use of early implantation of diaphragm pacing
Participant Level: Material is suitable for any level.
Target Audience: Any healthcare team (physician, respiratory therapy, nursing, physical therapy and consumers) member who may be involved in the care of ventilated patients.
ABSTRACT
Introduction: Dr. Onders General Surgeon, United States (15 minutes)
Spinal Cord Injury (SCI) can lead to catastrophic respiratory failure requiring invasive mechanical ventilation (MV). During the initial hospitalization there is a 60% ventilator associated pneumonia (VAP) rate. MV drastically increases the mortality rate of patients of all ages. According to the National Spinal Cord Injury Statistics, there has been a drastic decline in survival from 2010 to 2018 for a 20 year old SCI on MV from 17.1 years to 11.3 years. MV frequently leads to a delay in rehabilitation which subsequently decreases quality of life.
This workshop intends to review basic respiratory mechanics in SCI that lead to mechanical ventilation, the problems associated with mechanical ventilation and the role of diaphragm pacing in this population. Recent reports demonstrate that DP is associated with a significant decrease in short term mortality of 15% to 3% (Kerwin et al, 2018) and improved median long term survival to 22.2 years (Onders et al, 2018).
Chronic Mechanical Ventilation in Spinal Cord Injury- The Dutch Experience: Dr. Wijkstra Pulmonologist, Netherlands (20 minutes)
Spinal cord injured patients, even those with low thoracic injuries have some degree of respiratory compromise. When levels are in the high cervical region, mechanical ventilation is often needed and becomes chronic in 30% of the population. Despite chronic mechanical ventilation, sputum immobilization is frequently present and pneumonia will develop. Management of chronic mechanical ventilation will be discussed. Optimizing the care of patients on chronic mechanical can decrease the complications. Review of management techniques will be highlighted.
Chronic Respiratory Failure and its effect on Spinal Cord Rehabilitation: Dr. Benito Rehabilitation Specialist, Spain (20 minutes)
It is widely understood SCI patients progress optimally when transitioned from ICU after initial injury to SCI rehabilitation. For patients dependent on tracheostomy mechanical ventilation, rehabilitation efforts can be thwarted. First, there are minimal facilities willing and able to accommodate a ventilated patient. Second, accommodating the actual ventilator and tubing can interfere with activities. Management of respiratory failure while optimizing rehabilitation will be addressed. The transition to diaphragm pacing as a ventilatory mode in a rehabilitation hospital will also be highlighted.
Temporary Diaphragm Pacing During the Acute Injury Phase: Dr. Landscheid Trauma Surgeon, Germany (20 minutes)
Ventilator Induced Diaphragm Dysfunction rapidly occurs in patients post traumatic injury while on MV. New mechanisms to shorten the initial ICU stay can include the use of temporary diaphragm pacing to maintain diaphragm muscle which will be reviewed. Early direct visualization of the diaphragm can also identify non-weanable patients. An acute trauma hospital experience from initial ventilator management and assessment for diaphragm pacing will be discussed.
Fifteen minutes will be left for questions and discussion.
Biography
Dr Raymond P. Onders is Chief of General Surgery at University Hospitals Cleveland Medical Center and Professor of Surgery at Case Western Reserve University School of Medicine. Over the last 20 years, he has focused his research efforts on ways to help people with spinal cord injuries and other patients breathe naturally using their own diaphragm. Diaphragm pacing, electrical stimulation of the diaphragm muscle, was a new technology aimed at either replacing or delaying the need for mechanical ventilation or maintaining and improving normal breathing. One of his first research subjects was the late Christopher Reeve (Superman). Diaphragm pacing technology was recognized as one of the most important medical innovations at the 6th Medical Innovation Summit.
He has authored numerous publications and book chapters on the primary muscle of breathing –the diaphragm. He has lectured around the world to help spread this knowledge training surgeons to do the diaphragm pacing operation in 28 countries which has helped countless patients worldwide. His present research focuses on using diaphragm pacing to shorten the time to wean from a ventilator on all intensive care unit patients which is one of the largest health care expenditures in the United States.
