title: Synergistic impact of acute kidney injury and high level of cervical spinal cord injury on the weaning outcome of patients with acute traumatic cervical spinal cord injury.
abstract: BACKGROUND
  Respiratory neuromuscular impairment severity is known to predict weaning outcome among patients with cervical spinal cord injury; however, the impact of non-neuromuscular complications remains unexplored. This study was to evaluate possible neuromuscular and non-neuromuscular factors that may negatively impact weaning outcome.
  
  
  METHODS
  From September 2002 to October 2012, acute traumatic cervical spinal cord injury patients who had received mechanical ventilation for >48h were enrolled and divided into successful (n=54) and unsuccessful weaning groups (n=19). Various neuromuscular, non-neuromuscular factors and events during the intensive care unit stay were extracted from medical charts and electronic medical records. Variables presenting with a significant difference (p<0.2) between these two groups were included in the univariate analysis. Following univariate analysis, those significantly different variables (p<0.05) were subjected to multivariate logistic regression to identify independent predictors of unsuccessful weaning.
  
  
  RESULTS
  Compared to successful weaning patients, unsuccessful weaning patients were older; more often had high level of cervical spinal cord injury (C1-3), lower pulse rates, and lower Glasgow Coma Scale score on admission, higher peak blood urea nitrogen, lower trough albumin, and lower trough blood leukocyte counts. Furthermore, unsuccessful weaning patients had a higher incidence of pneumonia, acute respiratory distress syndrome, shock and acute kidney injury during the intensive care unit stay. Multivariate logistic regression analysis revealed acute kidney injury and high level of cervical spinal cord injury were independent risk factors for failure of weaning. Importantly, patients with both risk factors showed a large increase in odds ratio for unsuccessful weaning from mechanical ventilation (p<0.001).
  
  
  CONCLUSIONS
  The presence of acute kidney injury during the intensive care unit stay and high level of cervical spinal injury are two independent risk factors that synergistically work together producing a negative impact on weaning outcome.
authors: Institute of Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Taipei, Taiwan. Electronic address: wkyu2@yahoo.com.tw.
authors: Wen-Kuang
authors: WK
authors: Yu
authors: Institute of Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Taipei, Taiwan. Electronic address: kuohsink@ms67.hinet.net.
authors: Hsin-Kuo
authors: HK
authors: Ko
authors: Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: liho@vghtpe.gov.tw.
authors: Li-Ing
authors: LI
authors: Ho
authors: School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Critical Care Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan. Electronic address: jiahorng.wang@gmail.com.
authors: Jia-Horng
authors: JH
authors: Wang
authors: Institute of Physiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: yrkou@ym.edu.tw.
authors: Yu Ru
authors: YR
authors: Kou
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D000367:Age Factors; D066193:Cervical Cord / Q000293:injuries*; D015897:Comorbidity; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013624:Taiwan / Q000453:epidemiology; D015300:Ventilator Weaning
keywords: Acute kidney injury; Cervical spinal cord injury; Respiratory failure; Weaning from mechanical ventilation