Acute respiratory distress syndrome and acute lung injury in patients with vertebral column fracture(s) and spinal cord injury: a nationwide inpatient sample study

Abstract

Study design: Retrospective Nationwide Inpatient Sample (NIS) study. Objectives: To determine national trends in prevalence, risk factors and mortality for vertebral column fracture (VCF) and spinal cord injury (SCI) patients with and without acute respiratory distress syndrome/acute lung injury (ARDS/ALI). Setting: United States of America, 1988 to 2008. Methods: The NIS was utilized to select 284 612 admissions for VCF with and without acute SCI from 1988 to 2008 based on ICD-9-CM. The data were stratified for in-hospital complications of ARDS/ALI. Results: Patients with SCI were more likely to develop ARDS/ALI compared with those without (odds ratio (OR): 4.9, 95% confidence interval (CI) 4.7-5.2, Po0.001). Compared with patients with lumbar fractures, those with cervical, thoracic and sacral fractures were more likely to develop ARDS/ALI (Po0.001). ARDS/ALI was statistically more prevalent (Po0.01) in VCF/SCI patients with epilepsy, sepsis, cardiac arrest, congestive heart failure (CHF), hypertension, chronic obstructive pulmonary disease and metabolic disorders. Patients with female gender, surgery at rural practice setting, and coronary artery disease and diabetes were less likely to develop ARDS/ALI (Po0.001). VCF/SCI patients who developed ARDS/ALI were more likely to die in-hospital than those without ARDS/ALI (OR 6.5, 95% CI 6.0-7.1, Po0.001). Predictors of in-hospital mortality after VCF/SCI include: older age, male sex, epilepsy, sepsis, hypertension, CHF, chronic obstructive pulmonary disease and liver disease. Patients who developed ARDS/ALI stayed a mean of 25 hospital days (30-440 days) while patients without ARDS/ALI stayed a mean of 6 days (7-868 days, Po0.001). Conclusion: Our analysis demonstrates that SCI patients are more at risk for ARDS/ALI, which carries a significantly higher risk of mortality.

Systemic Inflammatory Responses and Lung Injury following Hip Fracture Surgery Increases Susceptibility to Infection in Aged Rats

“…In previous studies, inflammatory-associated lung injury was reported to occur following bilateral femur fracture (with fixation) or a vertebral column fracture [26, 38, 39]. However, little information exists regarding adverse effects of the initial traumatic insult and surgical procedures on the lung tissues of aged individuals.…”

A comparison of high vs standard tidal volumes in ventilator weaning for individuals with sub-acute spinal cord injuries: a site-specific randomized clinical trial

“…6,7 Acute SCI patients are certainly at higher risk for ARDS/acute lung injury and death 8 and should be managed with a low tidal volume protocols. Sub-acute SCI patients, however, are generally not felt to be at risk for ARDS and may not need lung-protective ventilation.…”

Atypical presentation of Covid-19 in persons with spinal cord injury

“…In summary, SCI induced respiratory dysfunction increases susceptibility to viral pneumonia caused by Covid-19 and likely increased morbidity and mortality compared to their able-bodied counterparts. Furthermore, Veeravagu et al found that persons with SCI are at greater risk of acute respiratory distress syndrome (ARDS) (~95% incidence in critically ill persons with Covid-19) [6]. We suspect that, rather than cough, fever and shortness of breath (typical presenting symptoms in able-bodied persons), hypoxia (<90% SpO2), a worsened ability to clear secretions and tachypnea may be the initial symptoms in persons with SCI.…”