title: A comparison of high vs standard tidal volumes in ventilator weaning for individuals with sub-acute spinal cord injuries: a site-specific randomized clinical trial.
abstract: METHODS
  Prospective, randomized, controlled parallel group trial with single-blinded data analysis.
  
  
  OBJECTIVE
  To determine the safety and efficacy of higher (20 ml kg(-1) ideal body weight (IBW)) vs standard (10 ml kg(-1) IBW) tidal volumes (Vt) for patients with sub-acute traumatic tetraplegia during ventilator weaning using a 14-day (minimum) weaning protocol.
  
  
  METHODS
  United States regional spinal cord injury treatment center.
  
  
  METHODS
  Thirty-three ventilator requiring inpatients were randomized to either the higher (Group 1) or the standard (Group 2) Vt protocol. Initially, all patients were ventilated at 10 ml kg(-1) IBW Vt and 5 cm H(2)O [corrected] of PEEP for 72 h. For Group 1, Vt was raised 100 ml kg(-1) until reaching target Vt of 20 ml kg(-1) IBW. Group 2 was maintained at Vt of 10 ml kg(-1) IBW. Plateau pressures were kept at or below 30 cm H(2)O. [corrected]. Safety outcomes included incidence of adverse events.
  
  
  RESULTS
  Because of smaller than expected enrollment, evaluation of efficacy was not possible. Therefore, we report the safety outcomes of 33 study participants. The 16 patients in Group 1 and 17 patients in Group 2 were demographically similar at baseline, except for age. The average age was 39.3 years in Group 1 and 27.2 years in Group 2, (P=0.002). There was no difference in median days to wean: 14.5 days in Group 1 and 14 days in Group 2. The incidence of adverse pulmonary events was similar between groups.
  
  
  CONCLUSIONS
  Higher tidal volumes can be safely utilized during weaning of patients with tetraplegia from mechanical ventilation using a 14-day weaning protocol.
authors.affiliation: National Jewish Health, Denver, CO, USA.|Research Department, Craig Hospital, Englewood, CO, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Fenton
authors.affiliation: National Jewish Health, Denver, CO, USA.|Research Department, Craig Hospital, Englewood, CO, USA.
authors.forename: M L
authors.initials: ML
authors.lastname: Warner
authors.affiliation: Research Department, Craig Hospital, Englewood, CO, USA.|Department of Physical Medicine and Rehabilitation, University of Colorado, Denver, CO, USA.
authors.forename: D
authors.initials: D
authors.lastname: Lammertse
authors.affiliation: Research Department, Craig Hospital, Englewood, CO, USA.
authors.forename: S
authors.initials: S
authors.lastname: Charlifue
authors.affiliation: Department of Respiratory Care, Swedish Medical Center, Englewood, CO, USA.
authors.forename: L
authors.initials: L
authors.lastname: Martinez
authors.affiliation: Research Department, Craig Hospital, Englewood, CO, USA.
authors.forename: A
authors.initials: A
authors.lastname: Dannels-McClure
authors.affiliation: Research Department, Craig Hospital, Englewood, CO, USA.
authors.forename: S
authors.initials: S
authors.lastname: Kreider
authors.affiliation: Research Department, Craig Hospital, Englewood, CO, USA.
authors.forename: C
authors.initials: C
authors.lastname: Pretz
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000293:injuries; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013119:Spinal Cord Injuries / Q000150:complications* / Q000503:physiopathology; D013990:Tidal Volume / Q000502:physiology*; D015300:Ventilator Weaning / Q000379:methods*