Pulmonary Dysfunction Following Traumatic Quadriplegia

McMichan, John C.

doi:10.1001/jama.1980.03300320020014

Cited by 164 publications

(41 citation statements)

References 7 publications

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“…23 Incidence of respiratory complications Seven papers reported the effect of various interventions on the incidence of respiratory complications. 10,[28][29][30][31][32][33] Respiratory complications were defined as pneumonia, atelectasis, or respiratory insufficiencyFa diagnosis that included respiratory failure, pneumonia, respiratory infection, and oxygen desaturation. Five of the studies were retrospective case series 10,[28][29][30][31][32] and the remaining two studies were cohort designs that used a retrospective control group.…”

Section: Results: Physiological Outcomesmentioning

confidence: 99%

“…10,[28][29][30][31][32][33] Respiratory complications were defined as pneumonia, atelectasis, or respiratory insufficiencyFa diagnosis that included respiratory failure, pneumonia, respiratory infection, and oxygen desaturation. Five of the studies were retrospective case series 10,[28][29][30][31][32] and the remaining two studies were cohort designs that used a retrospective control group. 10,33 There was moderate evidence that a comprehensive clinical pathway 33 and a respiratory protocol 10 reduced respiratory complications.…”

Section: Results: Physiological Outcomesmentioning

confidence: 99%

“…3 Aggressive respiratory management has been advocated for the prevention and treatment of pulmonary complications and has been associated with improved outcomes. 2,10,11 The frequency of respiratory complications is correlated with injury level and severity, associated injuries, and the age and pre-existing co-morbidities of the patient. 8 The nature of the pulmonary complication can also vary with the level of the injury; with high injuries (C1-C4) being more likely to develop pneumonia and lower cervical injuries atelectasis.…”

Section: Introductionmentioning

confidence: 99%

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The acute respiratory management of cervical spinal cord injury in the first 6 weeks after injury: a systematic review

et al. 2010

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Study design: Systematic review. Objectives: Identify, evaluate, and synthesize evidence regarding the effectiveness of various treatment strategies for the respiratory management of acute tetraplegia. Setting: Melbourne, Australia. Methods: A search of multiple electronic databases (Medline, Cinahl, EMBASE, Cochrane Library, Web of Science, http://www.guideline.gov and http://www.icord.org/scire) was undertaken accompanied by the reference lists of all relevant articles identified. Methodological quality was assessed using the Newcastle-Ottawa Scale and the PEDro Scale. Descriptive analysis was performed. Results: Twenty-one studies including 1263 patients were identified. The majority of the studies were case series (n ¼ 13). A variety of interventions were used for the management of respiratory complications. Mortality (ARR ¼ 0.4, 95% confidence interval (CI) 0.18, 0.61), the incidence of respiratory complications (ARR ¼ 0.36, 95% CI (0.08, 0.58)), and requirement for a tracheostomy (ARR ¼ 0.18, 95% CI (À0.05, 0.4)) were significantly reduced by using a respiratory protocol. A clinical pathway reduced duration of mechanical ventilation by 6 days 95% CI (À0.56, 12.56), intensive care unit length of stay by 6.8 days 95% CI (0.17-13.77) and costs. Intubation, mechanical ventilation, and tracheostomy are the mainstay of respiratory management for complete injuries above the level of C5. Conclusion: This review showed a clinical pathway with a structured respiratory protocol that includes a combination of treatment techniques provided regularly is effective in reducing respiratory complications and cost. The overall study quality was moderate and further studies using specific interventions that target respiratory complications are associated with specific regions of the cervical spine using more methodologically rigorous designs are required.

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Section: Results: Physiological Outcomesmentioning

confidence: 99%

Section: Results: Physiological Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The acute respiratory management of cervical spinal cord injury in the first 6 weeks after injury: a systematic review

et al. 2010

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“…Intensive respiratory treatment, protocolized care and non-invasive ventilation have been shown to reduce the need for tracheostomy placement. 9,16,17 Further study is required to investigate the effect of intensive respiratory therapy on airway management in patients with CSCI below the level of C3.…”

Section: Discussionmentioning

confidence: 99%

A classification and regression tree to assist clinical decision making in airway management for patients with cervical spinal cord injury

et al. 2010

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Study design: This was a prospective observational study. Objectives: To review airway management of patients with acute cervical spinal cord injury (CSCI) who are admitted to the intensive care unit (ICU) and to develop a classification and regression tree (CART) to direct clinical decision making in airway management. Setting: This study was carried out in Australia. Results: A total of 114 patients were included. Tracheostomy insertion occurred in 68 patients (59.7%). Using CART analysis, it was found that the variables forced vital capacity, the volume of pulmonary secretion and gas exchange were predictive of airway management on 82.3% occasions with an 8.7% extubation failure rate. Conclusion: A CART can be useful in clinical decision making regarding airway management in CSCI.

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“…19,20 Earlier studies imply that only with progressive resistance exercise in already functional muscles does one ®nd reports of a signi®cant increase in muscle strength or VC in the years following injury. 21,22 Carter noted in his study on experiences with high tetraplegics that patients admitted several months after their injury were still capable of signi®cant gains in their VC after an inpatient rehabilitation program using appropriate respiratory exercises and therapy.…”

Section: Discussionmentioning

confidence: 99%

Vital capacity in tetraplegics twenty years and beyond

2001

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Objectives: To observe the trends in vital capacity (VC) over time in tetraplegics 20 years and more after injury, the e ects of age at injury, severity of injury and gender on this trend. Methods: The medical records of all spinal cord injured persons admitted to a regional spinal injury center from January 1960 to December 1996 were reviewed. Fifty-seven patients had documented post-rehabilitation VC (mean 1.3+1.1 years) and VC at 10 (mean 11.8+2.69) and 20 (20.60+2.67) years post injury and beyond. Results: The mean age at injury was 23.2+9.1 years. Severity of injury when classi®ed according the system proposed by Coll et al were: Group 1: C1 ± 4 Frankel A injury: 11.6%, Group 2: C5 ± 8 Frankel A injury: 55.6%, Group 3: C2 ± 8 Frankel B and C: 29.8% and Group 4: C2 ± 8 Frankel D: 3.5% respectively. The mean VC at initial, 10 and 20 years post injury was 2586+948, 2803+940 and 2525+818 cc respectively. Multivariate analysis of variance revealed that there was signi®cant di erence in VC over a 20 year period, (F(2,54)=8.43, P50.05). The di erence between VC at 10 years and VC at 20 years accounted for the 19.8% of the variance in VC over time (F(1,55)=12.35, P50.05). Age at injury, gender and severity of injury did not have a signi®cant in¯uence on the rate of decline in VC. Analysis of a subset of 26 patients who were followed up more than 20 years post injury (range 22 to 34.5 years) revealed similar,

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Pulmonary Dysfunction Following Traumatic Quadriplegia

Cited by 164 publications

References 7 publications

The acute respiratory management of cervical spinal cord injury in the first 6 weeks after injury: a systematic review

The acute respiratory management of cervical spinal cord injury in the first 6 weeks after injury: a systematic review

A classification and regression tree to assist clinical decision making in airway management for patients with cervical spinal cord injury

Vital capacity in tetraplegics twenty years and beyond

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