Predicting the need for tracheostomy in patients with cervical spinal cord injury

Leelapattana, Pittavat; Fleming, Jennifer C.; Gurr, Kevin R.; Bailey, Stewart I.; Parry, Neil; Bailey, Christopher S.

doi:10.1097/ta.0b013e318251fb34

Cited by 61 publications

(63 citation statements)

References 18 publications

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“…B erney et al [106] also found volume of pulmonary secretions and gas exchange to be predictive of airway management. Tracheostomy may be performed as early as day 4 following anterior cervical surgery with no increase in the incidence of wound or implant infection [118], and has been associated with fewer days on the ventilator and a shorter hospital stay in selected patients [119]. …”

Section: Respiratory Treatmentmentioning

confidence: 99%

“…With increased survival after high SCI, long-term ventilation is now 6–8% prevalent in the developed world [119, 138–140]. It is a common assumption amongst the able-bodied that life with a high SCI would not be worth living [3]; however, research into perceived QOL in the ventilator-associated SCI group indicates that this is not the case.…”

Section: Respiratory Treatmentmentioning

confidence: 99%

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Respiratory problems and management in people with spinal cord injury

Berlowitz

Wadsworth

Ross

2016

Breathe

142

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Spinal cord injury (SCI) is characterised by profound respiratory compromise secondary to the level of loss of motor, sensory and autonomic control associated with the injury. This review aims to detail these anatomical and physiological changes after SCI, and outline their impact on respiratory function. Injury-related impairments in strength substantially alter pulmonary mechanics, which in turn affect respiratory management and care. Options for treatments must therefore be considered in light of these limitations.Key pointsRespiratory impairment following spinal cord injury (SCI) is more severe in high cervical injuries, and is characterised by low lung volumes and a weak cough secondary to respiratory muscle weakness.Autonomic dysfunction and early-onset sleep disordered breathing compound this respiratory compromise.The mainstays of management following acute high cervical SCI are tracheostomy and ventilation, with noninvasive ventilation and assisted coughing techniques being important in lower cervical and thoracic level injuries.Prompt investigation to ascertain the extent of the SCI and associated injuries, and appropriate subsequent management are important to improve outcomes.Educational aimsTo describe the anatomical and physiological changes after SCI and their impact on respiratory function.To describe the changes in respiratory mechanics seen in cervical SCI and how these changes affect treatments.To discuss the relationship between injury level and respiratory compromise following SCI, and describe those at increased risk of respiratory complications.To present the current treatment options available and their supporting evidence.

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Section: Respiratory Treatmentmentioning

confidence: 99%

Section: Respiratory Treatmentmentioning

confidence: 99%

Respiratory problems and management in people with spinal cord injury

Berlowitz

Wadsworth

Ross

2016

Breathe

142

View full text Add to dashboard Cite

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“…In a retrospective study [80], early tracheostomy (<day 7) in traumatic SCI patients was associated with a shorter duration of mechanical ventilation, shorter length of ICU stay, and decreased laryngotracheal complications, but they could not demonstrate that early placement prevents the risk of ventilator-associated pneumonia or affects the mortality rate. A retrospective review of patients with cervical SCI [81] verified that tracheostomy decreased the mortality rate and pulmonary complications compared with endotracheal intubation longer than 7 days, and they demonstrated that early tracheostomy facilitates quicker extubation and shorter hospital stays. They recommend early tracheostomy if at least two of the following three factors are present: the Injury Severity Score (ISS) > 32, the patient has a complete SCI, or PaO 2 /FiO 2 ratio <300 3 days after mechanical ventilation was initiated.…”

Section: Tracheostomymentioning

confidence: 99%

Respiratory Management in the Patient with Spinal Cord Injury

Galeiras

Sedes

Fariña

et al. 2013

BioMed Research International

122

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Spinal cord injuries (SCIs) often lead to impairment of the respiratory system and, consequently, restrictive respiratory changes. Paresis or paralysis of the respiratory muscles can lead to respiratory insufficiency, which is dependent on the level and completeness of the injury. Respiratory complications include hypoventilation, a reduction in surfactant production, mucus plugging, atelectasis, and pneumonia. Vital capacity (VC) is an indicator of overall pulmonary function; patients with severely impaired VC may require assisted ventilation. It is best to proceed with intubation under controlled circumstances rather than waiting until the condition becomes an emergency. Mechanical ventilation can adversely affect the structure and function of the diaphragm. Early tracheostomy following short orotracheal intubation is probably beneficial in selected patients. Weaning should start as soon as possible, and the best modality is progressive ventilator-free breathing (PVFB). Appropriate candidates can sometimes be freed from mechanical ventilation by electrical stimulation. Respiratory muscle training regimens may improve patients' inspiratory function following a SCI.

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“…[10][11][12] Early tracheostomy (ET) has been shown to decrease intensive care unit (ICU) length of stay, overall hospital length of stay, and facilitate weaning from MV. [13][14][15][16] As the benefits of tracheostomy appear most pronounced when performed early during hospitalization, identification of patients who are unlikely to wean from MV would permit ET.…”

mentioning

confidence: 99%