Separation from mechanical ventilation and survival after spinal cord injury: a systematic review and meta-analysis

Schreiber, Annia F.; Garlasco, Jacopo; Vieira, Fernando; Lau, Yie Hui; Stavi, Dekel; Lightfoot, David; Rigamonti, Andrea; Burns, Karen; Friedrich, Jan O.; Singh, Jeffrey M.; Brochard, Laurent J.

doi:10.1186/s13613-021-00938-x

Annals of Intensive Care

Table 1 Main outcomes after injury

From: Separation from mechanical ventilation and survival after spinal cord injury: a systematic review and meta-analysis

Outcomes after injury	Means and proportions	Overall (n = 14,637)	ICU (n = 13,763)	Rehab unit (n = 874)	Number of studies	Subgroup differences
Outcomes after injury	Means and proportions	Overall (n = 14,637)	ICU (n = 13,763)	Rehab unit (n = 874)	Number of studies	p-value^#	p-value^# (excluding Branco et al. and Anand et al.)
Weaning success, n (%)	Crude	1299/1942 (66.9%)	674/1068 (63.1%)	625/874 (71.5%)	24 (10 + 14)
Weaning success, n (%)	Meta-analytic	67.8% [54.2–79%]	63.1% [45.2–77.9%]	71.5% [51.1–85.8%]	24 (10 + 14)	0.5059	–
Partial weaning, n (%)	Crude	75/195 (38.5%)	2/44 (4.5%)	73/151 (48.3%)	6 (1 + 5)
Partial weaning, n (%)	Meta-analytic	31.9% [7.4–73.3%]	4.5% [1.1–16.4%]	43.3% [11.1–82.4%]	6 (1 + 5)	0.0582	–
Partial or total weaning, n (%)	Crude	1351/1942 (69.6%)	676/1068 (63.3%)	675/874 (77.2%)	24 (10 + 14)
Partial or total weaning, n (%)	Meta-analytic	75.4% [63.9–84.1%]	63.7% [45.6–78.6%]	82.3% [69.6–90.4%]	24 (10 + 14)	0.0610	–
Tracheostomy, n (%)	Crude	8344/13371 (62.4%)*	8142/13165 (61.8%)*	202/206 (98.1%)	27 (19 + 8)
Tracheostomy, n (%)	Meta-analytic	93.9%* [77.2–98.6%]	80.9% [51.4–94.4%]	100% [9.1–100%]	27 (19 + 8)	0.2201	0.1829
Decannulation, n (%)	Crude	150/291 (51.5%)	33/131 (25.2%)	117/160 (73.1%)	10 (3 + 7)
Decannulation, n (%)	Meta-analytic	69.4% [39.3–88.8%]	30% [10.9–60.1%]	82.9% [53–95.4%]	10 (3 + 7)	0.0135	–
Duration of mechanical ventilation, days	Meta-analytic	30.9 [24.8–37.1]	26.9 [19.8–34.1]	46.1 [28.3–63.9]	22 (14 + 8)	0.0503	0.0850
Duration of mechanical ventilation, days			26.9 [19.8–34.1]	96.5 [65.1–127.8]^§	22 (14 + 8)	< 0.0001	< 0.0001
ICU/rehab days	Meta-analytic	25.7 [20.2–31.2]	22.9 [17.3–28.6]	78.3 [49.1–107.6]	22 (20 + 2)	0.0003	0.0003
Hospital days	Meta-analytic	44 [37.3–50.7]	44 [37.3–50.7]	–	13 (13 + 0)	-	-
Pneumonia, n (%)	Crude	814/1927 (42.1%)	738/1630 (45.3%)	76/297 (25.6%)	21 (14 + 7)
Pneumonia, n (%)	Meta-analytic	38.3% [25.7–52.8%]	40.0% [27.4–54.0%]	35.5% [11.3–70.5%]	21 (14 + 7)	0.8132	-
Mortality, n (%)	Crude	1223/13756 (8.9%)	1210/13331 (9.1%)	13/425 (3.1%)	25 (20 + 5)
Mortality, n (%)	Meta-analytic	6.3% [4.1–9.6%]	7.7% [5.2–11.2%]	0.8% [0–18.5%]	25 (20 + 5)	0.1751	0.1825

Meta-analytic means and proportions were computed through the “metamean” and “metaprop” functions (R package “meta”), respectively
^*Crude and meta-analytic proportions differed appreciably because of the very large sample size of one of the included studies, Branco et al. [32] (5256 patients, weighting for 73% of the total in the crude calculation), which enrolled patients with very low prevalence of tracheostomy (21%) and whose weighting in the pooled meta-analytic result was more comparable with those of the other studies
^#p-values yielded by the subgroup analyses: ICUs vs rehabilitation units with and without Branco et al. [32] and Anand et al. [35]
^§Including duration of mechanical ventilation prior to admission and during the stay in rehabilitation

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