Trendelenburg chest optimization prolongs spontaneous breathing trials

Chest optimization, an evidence-based p rotocolguided multimodal chest physio therapy con sisting of bo dy positioning, sputu m mobilization, bronchodilation, an d lu ng hyperinflation, may be ro utinely adm inistered to venti latordependent patients with low cervical spinal cord injury (CSCI) for i mproving p ulmonary fu nctional o utcomes that facilitate weaning from mechanical ventilation. We undertook this study to determine whether position-specific chest optimization was associated with changes in s pontaneous breathing trial (SBT) duration. Cardi ac output (CO), al veolar m inute volume (MValv), carbon dioxide elimination (VCO2), and static chest compliance (Cst) were measured during chest opt imization; then MValv and rap id shallow breathi ng index (RSBI) were measured during SBT. Study participants (N = 1 2) were clinically stable ventilator-dependent patients with low CSCI. Trendelenburg chest optimization (TCO) was associated with significant i ncreases in SBT ( p < 0.00 1), CO (p < 0. 001), MValv (p < 0.003), VCO 2 (p < 0.001), an d C st (p < 0.002). SBT following TCO was associated with significant increases in MValv (p < 0.03) and RSBI (p < 0.002). These preliminary findings su ggest th e im portance of prop er recum bent bo dy positioning during evidence-based, protocol-guided multimodal chest physiotherapy for ventilator-dependent patients with low CSCI.