Résumé :
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Survival after spinal cord injury is reduced due to respiratory morbidity especially for ventilated tetraplegics. This study of survival after mechanical ventilation following acute spinal cord injury compares those who wean with those who remain ventilator dependent. The case notes of all 262 patients known to have had assisted ventilation at the NWRSIC between the years 1981 and end of 2005were reviewed. Kaplan Meier computations of survival from the day of first ventilation up to end of 2005 were made in age groups 1-30; 31-45; 46 and over. Full records were available for 189 patients ventilated for the first time after traumatic spinal cord, of whom 55 could not be weaned from mechanical ventilation. Over half were respiratory in nature in both weaned patients (32/134) and ventilated patients (19/55). Whilst the mean survival time of weaned patients was greater than that of ventilated patients within each age group, this was only significantly different within the age group 31-45 (236 vs 126 months, log rank p = 0.047. The mean survival time in the younger patients was 265 and 221 months forweaned and ventilated patients, and 132 and 97 months respectively for those aged over 46. The 19 patients with diaphragm pacing had similar survival to those mechanically ventilated, allowing for their younger age. The survival of ventilator dependent patients after spinal cord injury in this series is comparable to data from the US model centres, with life expectancy reduced to around 40% in the younger, and to nearly 25% of normal life expectancy in the older patients. However, those data suggests that, in the present series those who wean have a worse prognosis than comparable non-ventilated tetraplegics, in whom expected survival should be 50 - 40% of normal life expectancy.
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