6 Unfortunately, mechanical ventilation is one of the most costly consequences of cervical SCI due to the associated infectious risks, social isolation and financial and caregiver burdens. At the time of discharge from acute hospitalization, greater than 70% of patients with complete cervical SCI at C5 and above have historically been shown to require ongoing mechanical ventilation. 4 Although there have been promising results with phrenic nerve and diaphragm motor-point stimulation, 5 mechanical ventilation remains the mainstay of management for patients with respiratory failure after SCI. 3, 4 Indeed, diaphragmatic function is responsible for 65% of an individual’s forced vital capacity. 1 The greatest determinant of respiratory failure after acute SCI is the level and completeness of injury relative to the phrenic nucleus at C3–C5. 1, 2, 3 The pathophysiology of respiratory dysfunction in SCI is multifactorial, resulting from diaphragmatic weakness, accessory muscle weakness, impaired cough, decreased surfactant production and unopposed vagal tone leading to increased secretions and bronchospasm. Respiratory dysfunction remains a leading cause of morbidity and mortality after spinal cord injury (SCI). We suspect that some portion of the high success rate of ventilator weaning may be attributable to theophylline use in higher cervical SCI, in addition to our aggressive regimen of high volume ventilation, medication optimization and pulmonary toilet (positive pressure treatments and mechanical insufflation–exsufflation). Thirty-three patients (92%) achieved 16 h of ventilator-free breathing (VFB) and 30 patients (83%) achieved 24 h of VFB. Multivariate general linear models hypothesis tests revealed a significant syndromic interaction between theophylline treatment and SCI level (Wilks' Lambda, P=0.028, F (12,64)=2.116, η 2=0.256, 1− β=0.838), with post hoc testing demonstrating a significant interaction on PC1, explained by a positive correlation between improved forced vital capacity and time it took to reach 16 h of ventilator-free breathing. The NL-PCA returned three independent components that accounted for 95% of the variance in the data set. In total, 36 patients met inclusion criteria (2 C1, 5 C2, 11 C3, 14 C4 and 4 C5). A nonlinear, categorical principal component analysis (NL-PCA) was performed to test the multivariate interaction of respiratory outcomes from patients ( N=36) being weaned off ventilator support after acute SCI with ( N=15) or without ( N=21) theophylline treatment. Retrospective chart review of patients consecutively admitted to Santa Clara Valley Medical Center between May 2013 and December 2014 for ventilator weaning with C1–C5 American Spinal Injury Association Impairment Scale (AIS) A or B SCI, <3 months from injury and who had a tracheostomy in place. United States regional spinal cord injury (SCI) treatment center. To identify multivariate interactions of respiratory function that are sensitive to spinal cord injury level and pharmacological treatment to promote strategies that increase successful liberation from mechanical ventilation.
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