title: Risk factors for prolonged duration of mechanical ventilation in acute traumatic tetraplegic patients--a retrospective cohort study.
abstract: OBJECTIVE
  Respiratory complications constitute an important determinant of length of stay in tetraplegic patients. In a population of tetraplegic patients, we investigated the factors involved in the duration of mechanical ventilation (MV) and whether the duration of MV was associated with the long-term neurologic status.
  
  
  METHODS
  In a retrospective study in 3 intensive care units (ICUs) (January 2001 to December 2009), consecutive patients (≥ 18 years) hospitalized for acute (≤ 24 hours) traumatic tetraplegia were included in the study. Patients with severe brain injury or who died in the first 48 hours were excluded. The primary outcome was the duration of MV. The secondary outcomes were the American Spinal Injury Association (ASIA) motor score on ICU discharge and at 1 year.
  
  
  RESULTS
  A total of 164 consecutive adult patients with tetraplegia were analyzed. Median (interquartile range) ASIA motor scores were 15 (6-26) on admission, 22 (9-40) on ICU discharge (n = 145 survivors), and 37 (10-80) at 1 year (n = 52 complete follow-up). The median duration of MV was 11 (2-26) days. In multivariate analysis, MV duration increased with pneumonia (P < .0001), atelectasis (P = .0042), and tracheotomy (P < .0001). In exploratory analysis, an increased duration of MV was the only factor associated in multivariate analysis with a low ASIA motor score on ICU discharge (P = .0201) and at 1 year (P = .0003).
  
  
  CONCLUSIONS
  Prevention of pneumonia and atelectasis is critical for the reduction of MV in tetraplegic patients. Prolonged MV was independently associated with poor neurologic status.
authors.affiliation: Intensive Care Unit, Anesthesia and Critical Care Department, Hôtel Dieu-HME, University Hospital of Nantes and UPRES EA 3826: "Thérapeutiques cliniques et expérimentales des infections", Nantes, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Roquilly
authors.affiliation: Intensive Care Unit, Anesthesia and Critical Care Department, University Hospital of Rennes and INSERM U991 "Foie, métabolisme et cancer", Rennes, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Seguin
authors.affiliation: Intensive Care Unit, Anesthesia and Critical Care Department, University Hospital of Poitiers, France and INSERM U1070, Poitiers, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Mimoz
authors.affiliation: Cellule de Biostatistique, CHU Nantes-EA 4275-UFR de Pharmacie, University of Nantes, Nantes, France.
authors.forename: Fanny
authors.initials: F
authors.lastname: Feuillet
authors.affiliation: Medical Intensive Care Unit, Hôtel Dieu-HME, University Hospital of Nantes, Nantes, France.
authors.forename: Elise
authors.initials: E
authors.lastname: Rosenczweig
authors.affiliation: Intensive Care Unit, Anesthesia and Critical Care Department, University Hospital of Poitiers, France and INSERM U1070, Poitiers, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Chevalier
authors.affiliation: Intensive Care Unit, Anesthesia and Critical Care Department, Hôtel Dieu-HME, University Hospital of Nantes and UPRES EA 3826: "Thérapeutiques cliniques et expérimentales des infections", Nantes, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Loutrel
authors.affiliation: Intensive Care Unit, Anesthesia and Critical Care Department, University Hospital of Rennes and INSERM U991 "Foie, métabolisme et cancer", Rennes, France.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Malledant
authors.affiliation: Cellule de Biostatistique, CHU Nantes-EA 4275-UFR de Pharmacie, University of Nantes, Nantes, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Sebille
authors.affiliation: Intensive Care Unit, Anesthesia and Critical Care Department, Hôtel Dieu-HME, University Hospital of Nantes and UPRES EA 3826: "Thérapeutiques cliniques et expérimentales des infections", Nantes, France. Electronic address: karim.asehnoune@chu-nantes.fr.
authors.forename: Karim
authors.initials: K
authors.lastname: Asehnoune
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications*; D001261:Pulmonary Atelectasis / Q000150:complications*; D011782:Quadriplegia / Q000150:complications*; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000150:complications; D017741:Survivors; D013997:Time Factors; D014140:Tracheotomy / Q000009:adverse effects*
keywords: Atelectasis; Cervical spine injury/tetraplegia; Mechanical ventilation/complications; Neurological recovery; Pneumonia