Airway management in patients with suspected or confirmed traumatic spinal cord injury: a narrative review of current evidence

Abstract

Summary Around 1 million people sustain a spinal cord injury each year, which can have significant psychosocial, physical and socio‐economic consequences for patients, their families and society. The aim of this review is to provide clinicians with a summary of recent studies of direct relevance to the airway management of patients with confirmed or suspected traumatic spinal cord injury to promote best clinical practice. All airway interventions are associated with some degree of movement of the cervical spine; in general, these are very small and whether these are clinically significant in terms of impingement of the spinal cord is unclear. Manual in‐line stabilisation does not effectively immobilise the cervical spine and increases the likelihood of difficult and failed tracheal intubation. There is no clear evidence of benefit of awake tracheal intubation techniques in terms of prevention of secondary spinal cord injury. Videolaryngoscopy appears to cause a similar degree of cervical spine displacement as flexible bronchoscope‐guided tracheal intubation and is an appropriate alternative approach. Direct laryngoscopy does cause a slightly greater degree of cervical spinal movement during tracheal intubation than videolaryngoscopy, but this does not appear to increase the risk of spinal cord compression. The risk of spinal cord injury during tracheal intubation appears to be minimal even in the presence of gross cervical spine instability. Depending on the clinical situation, practitioners should choose the tracheal intubation technique with which they are most proficient and that is most likely to minimise cervical spine movement.

Management of acute cervical spinal cord injury in the non‐specialist intensive care unit: a narrative review of current evidence

“…high cervical SCI and/or hospital-acquired pneumonia); and to facilitate operative intervention for surgical management of the SCI and/or other injuries. The optimal tracheal intubation technique for minimising the risk of secondary SCI remains unclear; this has been discussed in depth in a recent review article [5]. In brief, all airway interventions result in some cervical spine movement, but these are typically very small, and it is uncertain whether this movement increases the risk of clinically significant spinal cord impingement even in cases of severe cervical spine instability.…”

Anxiety and Depression in Pediatric-Onset Traumatic Spinal Cord Injury: A Systematic Review

“…Pediatric patients are particularly vulnerable as experiencing TSCI during a critical developmental stage can have signi cant short-and long-term implications on their physical, mental, and social function [9,11]. While recent medical and surgical advances have resulted in improved quality of life and prolonged survival among patients with TSCI, and the physical aspects of TSCI have been well-studied [12][13][14][15][16][17][18], the psychological impact of TSCI is not well-documented [19]. The goal of TSCI treatment should not solely focus on the physical but provide holistic care by focusing on the psychological aspect of rehabilitation as well.…”