Långvarig ventialtorvård hos patienter med hög ryggmärgsskada- tid för urträning och bakslag i form av returer till intensivvårdsavdelning
Urträning från ventilatorRyggmärgsskadorTvärprofessionellt arbete,Respiratoriska komplikationerVentilator weaningSpinal cord injuriesAirway ManagementInterprofessional relationsRespiration disorders
Background: Patients with cervical spinal cord injuries are often dependent on a mechanical ventilator due to the damage on the innervation to breathing musculature. During rehabilitation they have to be trained to regain own breathing. This unweaning process may give respiratory complications, which are main causes to morbidity and death. These respiratory complications are traditionally treated in an intensive care unit (ICU), which means that the patients have to return back to these emergency units.Aim: To investigate number, length and causes of returns to intensive care units and the length of the weaning process. Further, to compare if a multidisciplinary approach to the weaning process may reduce ICU returns and to shorten the weaning process. This approach includes mainly that nurses and physiotherapists at the ordinary caring unit are trained to handle ventilators and coughing machines by themselves.Methods: The medical records of 26 patients with cervical spinal cord injuries were examined. All patients were tracheotomized and treated from year 2004 to2011 at the Sahlgenska University hospital in Göteborg, Sweden. Data about number of ICU returns, their lengths and causes as well as time for weaning were extracted from the records. Those 13 patients treated before the introduction of the multidisciplinary program in year 2009 were compared with those 13 treated after its implementation.Results: It was revealed that the patients in the latter group spent significantly fewer days returning to the ICU (Mann-Whitney; p=0.012). A strong tendency towards a shorter weaning process was also observed for this group (Mann-Whitney; p=0.063).Conclusion: An extended multidisciplinary mode of caring seems to be positive for the these patients. It reduces the returns to ICU and shortens the weaning process. This should in turn lower the risk for complications and increase patient satisfaction. However, a larger patient group is necessary for giving support to these suggestions.