A Comparison of High vs. Low Tidal Volumes in Ventilator Weaning for Individuals With Cervical Spinal Cord Injuries

Inclusion Criteria: * Traumatic SCI at levels C3 through C6, ASIA A, B, or C tetraplegia * Subacute admission to Craig Hospital between 2 weeks and 6 months post-injury * Completely ventilator-dependent (24 hours a day) at the time of admission to Craig Hospital * Age 18-55 years * Informed consent obtained Exclusion Criteria: * Concurrent severe traumatic brain injury resulting in inability to cooperate with wean protocol * Residual severe chest trauma (pneumothorax, recurrent pleural effusion \> one third hemithorax, indwelling chest tubes, flail chest, trapped lung, bilateral pulmonary contusions) * Residual esophageal trauma that may cause ongoing aspiration; * Current ARDS * Current VAP unresponsive to antibiotic therapy * Premorbid cardiomyopathy with ejection fraction \<30%, unstable angina, bullous emphysema, obstructive lung disease with forced expiratory volume \< 50% predicted, morbid obesity with BMI ≥ 35, increased intracranial pressure, neuromuscular disease, chronic liver disease Child-Pugh Class C, or history of bone marrow or solid organ transplantation * Critical illness polyneuropathy * Burns over more than 30 percent of their body-surface area * Current participation in another clinical trial * Any condition that, in the judgment of the investigator, precludes successful participation in the study