title: Pulmonary outcomes following specialized respiratory management for acute cervical spinal cord injury: a retrospective analysis.
abstract: METHODS
  Retrospective analysis.
  
  
  OBJECTIVE
  To identify multivariate interactions of respiratory function that are sensitive to spinal cord injury level and pharmacological treatment to promote strategies that increase successful liberation from mechanical ventilation.
  
  
  METHODS
  United States regional spinal cord injury (SCI) treatment center.
  
  
  METHODS
  Retrospective chart review of patients consecutively admitted to Santa Clara Valley Medical Center between May 2013 and December 2014 for ventilator weaning with C1-C5 American Spinal Injury Association Impairment Scale (AIS) A or B SCI, <3 months from injury and who had a tracheostomy in place. A nonlinear, categorical principal component analysis (NL-PCA) was performed to test the multivariate interaction of respiratory outcomes from patients (N=36) being weaned off ventilator support after acute SCI with (N=15) or without (N=21) theophylline treatment.
  
  
  RESULTS
  In total, 36 patients met inclusion criteria (2 C1, 5 C2, 11 C3, 14 C4 and 4 C5). The NL-PCA returned three independent components that accounted for 95% of the variance in the data set. Multivariate general linear models hypothesis tests revealed a significant syndromic interaction between theophylline treatment and SCI level (Wilks' Lambda, P=0.028, F (12,64)=2.116, η2=0.256, 1-β=0.838), with post hoc testing demonstrating a significant interaction on PC1, explained by a positive correlation between improved forced vital capacity and time it took to reach 16 h of ventilator-free breathing. Thirty-three patients (92%) achieved 16 h of ventilator-free breathing (VFB) and 30 patients (83%) achieved 24 h of VFB.
  
  
  CONCLUSIONS
  We suspect that some portion of the high success rate of ventilator weaning may be attributable to theophylline use in higher cervical SCI, in addition to our aggressive regimen of high volume ventilation, medication optimization and pulmonary toilet (positive pressure treatments and mechanical insufflation-exsufflation).
authors.affiliation: Department of Orthopedic Surgery, Stanford Hospitals and Clinics, Palo Alto, CA, USA.
authors.forename: E C
authors.initials: EC
authors.lastname: Zakrasek
authors.affiliation: Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Nielson
authors.affiliation: Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Kosarchuk
authors.affiliation: Department of Orthopedic Surgery, Stanford Hospitals and Clinics, Palo Alto, CA, USA.|Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Crew
authors.affiliation: Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA.|San Francisco VA Medical Center, San Francisco, CA, USA.
authors.forename: A R
authors.initials: AR
authors.lastname: Ferguson
authors.affiliation: Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA, USA.|Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: McKenna
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017711:Nonlinear Dynamics; D025341:Principal Component Analysis; D012138:Respiratory Therapy; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications* / Q000628:therapy*; D013806:Theophylline / Q000627:therapeutic use; D014139:Tracheostomy; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D014665:Vasodilator Agents; D013806:Theophylline