A Retrospective Review of Standardized Use of Bronchial Hygiene Pathway in Spinal Cord Injury Patients

Abstract

Background: Management of spinal cord injury ventilator-dependent patients in acute care rehabilitation has significant challenges. Acute care rehabilitation is a short-term setting for patients to meet goals that will impact long-term recovery. Mechanically ventilated patients, along with the goal of being liberated from the ventilator, also have several other functional goals to meet. Spinal cord injury brings significant challenges to these patients, especially in the management of secretions, often causing atelectasis and lung infections, which could impact patient progression and even mortality.

Methods: We reviewed data during 2018-22 timeframe of spinal cord injury ventilator-dependent patients admitted at Magee Rehabilitation. The patient dataset had more than 30 data fields. Patients with ventilator weaning not as a goal were excluded. The following data fields were extracted for this review: mucolytic protocol (yes/no); history of pneumonia (yes/no); off vent at discharge (yes/no). Patient data were stored in a password-protected drive. The project is exempt according to Jefferson IRB.

Results: A total of 71 patients were reviewed. Of these patients, 57 (80%) were placed on the bronchial hygiene pathway upon admission, and 14 (20%) were not placed on the pathway. 50 (70%) of the total patients reviewed had a recent history of pneumonia. Of these, 40 (70%) patients placed on the bronchial hygiene pathway had a recent history of pneumonia. 10 (71%) patients who were not placed on the bronchial hygiene pathway also had a recent history of pneumonia. 57 (80%) patients were discharged after being liberated from the ventilator. Out of this, 46 (81%) patients on the bronchial hygiene pathway were discharged without the ventilator, and 11 (79%) patients not on the bronchial hygiene pathway were discharged without the ventilator.

Conclusions: The results of the retrospective review suggest that even though no significant differences in ventilator liberation among patients on or not on the bronchial hygiene pathway were identified. The majority (80%) of the admitted mechanically ventilated patients were placed on the bronchial hygiene pathway, with significant success in meeting ventilator liberation goals of 81%. A standardized approach to secretion management and bronchial hygiene is extremely important for patients with spinal cord injuries. Further research is required to identify the benefits of standardized respiratory pathways for ventilator-dependent spinal cord rehabilitation patients.