Systematic Review of Incidence Studies of Pneumonia in Persons with Spinal Cord Injury

Abstract

Pneumonia continues to complicate the course of spinal cord injury (SCI). Currently, clinicians and policy-makers are faced with only limited numbers of pneumonia incidence in the literature. A systematic review of the literature was undertaken to provide an objective synthesis of the evidence about the incidence of pneumonia in persons with SCI. Incidence was calculated per 100 person-days, and meta-regression was used to evaluate the influence of the clinical setting, the level of injury, the use of mechanical ventilation, the presence of tracheostomy, and dysphagia. For the meta-regression we included 19 studies. The incidence ranged from 0.03 to 7.21 patients with pneumonia per 100 days. The main finding of this review is that we found large heterogeneity in the reporting of the incidence, and we therefore should be cautious with interpreting the results. In the multivariable meta-regression, the incidence rate ratios showed very wide confidence intervals, which does not allow a clear conclusion concerning the risk of pneumonia in the different stages after a SCI. Large longitudinal studies with a standardized reporting on risk factors, pneumonia, and detailed time under observation are needed. Nevertheless, this review showed that pneumonia is still a clinically relevant complication and pneumonia prevention should focus on the ICU setting and patients with complete tetraplegia.

Cervical spinal cord hemisection impacts sigh and the respiratory reset in male rats

“…Likewise the P di of the post‐sigh breath is also affected by C 2 SH. In the spinal cord injury population, maintenance of cardiorespiratory health is essential (Fogarty & Sieck, 2020 ; Raab et al., 2021 ; Randelman et al., 2021 ), with sighs highly important in maintaining lung ventilatory function (Housley et al., 1970 ; Katagiri et al., 1998 ; Lieske et al., 2000 ; Ramirez et al., 2022 ; Riede et al., 2020 ; Wuyts et al., 2011 ). Our results of reduced sigh P di amplitude likely impair the effectiveness of this behavior to stave of lung atelectasis.…”

Unplanned hospital admissions due to secondary health conditions after spinal cord injury: a population-based description of determinants of length of stay

“…Development of better in-hospital monitoring strategies to prevent or early diagnose complications, such as hospital acquired pressure ulcers, hospital-acquired infections is thus of outmost importance. Development of those strategies is depending on prognostic models for speci c complications such as hospital acquired pneumonia (23) or hospital acquired infections (24).…”

Systemic and Pulmonary Inflammation/Oxidative Damage: Implications of General and Respiratory Muscle Training in Chronic Spinal-Cord-Injured Patients

“…This phenomenon translates clinically into both decreased muscle strength (measured as peak inspiratory/expiratory pressure and respective flows) and decreased vital capacity and FEV1, which has been reported in multiple studies and linked to the decreased recruitment of alveolar units and the presence of atelectasis in these patients [ 20 ]. In addition, functional restrictions on defensive mechanisms such as cough and mucociliary clearance have been reported, which have been associated with an increased risk of lower respiratory infections [ 21 ]. Over time, due to their reduced participation in the ventilatory activity, atrophy of the respiratory muscles, a tendency to fibrosis, and decreased elasticity of the rib cage have been observed, resulting in an abnormal respiratory pattern that increases the ventilatory energy cost [ 22 , 23 ].…”