Weaning and decannulation in high cervical spinal cord injury using lung-protective ventilation

Background: High cervical spinal cord injury (SCI) often requires prolonged invasive mechanical ventilation (IMV) and tracheostomy. While SCI guidelines recommend tidal volumes >15 mL/kg during weaning, intensive care protocols favor lung-protective volumes (6–8 mL/kg). Evidence on outcomes with such volumes in SCI is limited. Method This retrospective cohort included SCI patients admitted to a specialized intensive care rehabilitation center (2019–2024). From admission to discharge, data included time to weaning from IMV, time to decannulation, diaphragm pacing (DPS), swallowing (FOIS; 1–7, ≤3 = tube feeding), post-decannulation non-invasive ventilation (NIV) or CPAP, mechanical insufflation-exsufflation (MI-E), infections, and mortality during admission, at 30 days and one year, with two-year follow-up. Results: Thirty-one patients were included; 25 required IMV. Median stay was 56 (34–108) days; tidal volume 6.9 (6.2–7.0) mL/kg. Nineteen of 25 were weaned after 38 (22–46) and 24 of 31 decannulated after 39 (25–60) days. Two with DPS weaned and decannulated after 172/190 days. The predominant injury was incomplete C4, with limited neurological improvement. FOIS improved from 2 to 6 (p