DIAPHRAGM PACING IMPROVES RESPIRATORY MECHANICS IN ACUTE CERVICAL SPINAL CORD INJURY.

INTRODUCTION Cervical spinal cord injury (CSCI) is devastating with ventilator-associated pneumonia being a main driver of morbidity and mortality. Laparoscopic diaphragm pacing implantation (DPS) has been used for earlier liberation from mechanical ventilation. We hypothesized DPS would improve respiratory mechanics and facilitate liberation. METHODS We performed a retrospective review of acute CSCI patients between 1/2005-5/2017. Routine demographics were collected. Patients underwent propensity score matching based on age, ISS, ventilator days, hospital length of stay and need for tracheostomy. Patients with complete respiratory mechanics data were analyzed and compared. Those who did not have DPS (NO DPS) had spontaneous Vt recorded at time of ICU admission, at day 7 and day 14 and patients who had DPS had spontaneous Vt recorded before and after DPS. Time to ventilator liberation and changes in size of spontaneous tidal volume (Vt) for patients while on the ventilator were analyzed. Bivariate and multivariate logistic and linear regression statistics were performed using STATA v10. RESULTS Between 7/2011-5/2017 37 patients that had DPS were matched to 34 who did not (NO DPS). Following DPS there was a statistically significant increase in spontaneous Vt compared to NO DPS (+88mL vs. -13 mL; 95% CI 46 - 131 vs. -78 - 51 mL respectively; p=0.004). Median time to liberation after DPS was significantly shorter (10 vs. 29 days; 95% CI 6.5-13.6 vs 23.1-35.3 days; p<0.001). Liberation prior to hospital discharge was not different between the two groups. DPS placement was found to be associated with a statistically significant decrease in days to liberation and an increase in spontaneous Vt in multivariate linear regression models. CONCLUSIONS DPS implantation in acute CSCI patients produces significant improvements in spontaneous Vt and reduces time to liberation from mechanical ventilation. Prospective comparative studies are needed to define the clinical benefits and potential cost savings of DPS implantation. LEVEL OF EVIDENCE Level IIIStudy TypeRetrospective comparative study.