What are the perspectives for ventilated tetraplegics? A French retrospective study of 108 patients with cervical spinal cord injury

Quesnel, A.; Veber, Benoît; Proust, F.; Agasse, E.; Blanquart, F. Beuret; Vérin, Eric

doi:10.1016/j.rehab.2014.12.004

Cited by 11 publications

(7 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Only two patients died due to respiratory complications during admission, and two more required home ventilatory support at discharge. These data contrast with the 11% mortality and 6.5% ventilator-dependance rates previously reported in patients with high spinal cord injuries [14]. In our patients, the presence of a complete motor lesion was independently associated with a fourfold risk of respiratory complications.…”

Section: Discussioncontrasting

confidence: 99%

Predictors of respiratory complications in patients with C5–T5 spinal cord injuries

et al. 2020

View full text Add to dashboard Cite

Study design Retrospective chart audit. Objectives Describing the respiratory complications and their predictive factors in patients with acute traumatic spinal cord injuries at C5-T5 level during the initial hospitalization. Setting Hospital Vall d'Hebron, Barcelona. Methods Data from patients admitted in a reference unit with acute traumatic injuries involving levels C5-T5. Respiratory complications were defined as: acute respiratory failure, respiratory infection, atelectasis, non-hemothorax pleural effusion, pulmonary embolism or haemoptysis. Candidate predictors of these complications were demographic data, comorbidity, smoking, history of respiratory disease, the spinal cord injury characteristics (level and ASIA Impairment Scale) and thoracic trauma. A logistic regression model was created to determine associations between potential predictors and respiratory complications. Results We studied 174 patients with an age of 47.9 (19.7) years, mostly men (87%), with low comorbidity. Coexistent thoracic trauma was found in 24 (19%) patients with cervical and 35 (75%) with thoracic injuries (p < 0.001). Respiratory complications were frequent (53%) and were associated to longer hospital stay: 83.1 (61.3) and 45.3 (28.1) days in patients with and without respiratory complications (p < 0.001). The strongest predictors of respiratory complications were: previous respiratory disease (OR 5.4, 95% CI: 1.5-19.2), complete motor function impairment (AIS A-B) (OR 4.7, 95% CI: 2.4-9.5) and concurrent chest trauma (OR 3.73, 95% CI: 1.8-7.9). Conclusions Respiratory complications are common in traumatic spinal cord injuries between C5-T5. We identified previous respiratory disease, complete motor function impairment and the coexistence of thoracic trauma as predictors of respiratory complications. Identification of patients at risk might help clinicians to implement preventive strategies.

show abstract

Section: Discussioncontrasting

confidence: 99%

Predictors of respiratory complications in patients with C5–T5 spinal cord injuries

et al. 2020

View full text Add to dashboard Cite

show abstract

“…We thus considered NLI≥C4 as a predictor of tracheotomy. Of note, six studies [ 12 , 17 , 18 , 20 – 22 ] (1260 patients) focused on NLI using the ordered categorical variable method (C1, C2, C3, C4, etc.). To facilitate statistical calculations, we converted the ordered categorical variable of NLI into a dichotomous variable.…”

Section: Discussionmentioning

confidence: 99%

A Meta-Analysis of the Influencing Factors for Tracheostomy after Cervical Spinal Cord Injury

Wang

Guo²,

Fan

et al. 2018

BioMed Research International

View full text Add to dashboard Cite

Background Traumatic cervical spinal cord injury (CSCI) is a common disease that has high complication, disability, and mortality rates and a poor prognosis. Tracheostomy is an important supportive therapy for patients with CSCI. However, a consensus on the predictive factors for tracheostomy after CSCI has not been reached. Objective This meta-analysis study assessed the influencing factors for tracheostomy after CSCI. Methods We searched for relevant studies on the influencing factors for tracheostomy after CSCI. The extracted data were analyzed using RevMan 5.3 software. We calculated the odds ratio (OR) or mean difference (MD) and 95% confidence intervals (CIs). Results Sixteen eligible studies containing 9697 patients with CSCI were selected. The pooled OR (MD) and 95% CI of the influencing factors were as follows: age (mean ± SD): -0.98 (-4.00 to 2.03), advanced age: 1.93 (0.80 to 4.63), sex (male): 1.29 (1.12 to 1.49), American Spinal Injury Association Impairment Scale (AIS) A grade: 7.79 (5.28 to 11.50), AIS B grade: 1.15 (1.13 to 2.02), AIS C grade: 0.28 (0.20 to 0.41), AIS D grade: 0.04 (0.02 to 0.09), neurological level of injury (upper CSCI): 2.36 (1.51 to 3.68), injury severity score (ISS): 8.97 (8.11 to 9.82), Glasgow Coma Scale (GCS) score ≤8: 6.03 (2.19 to 16.61), thoracic injury: 1.78 (1.55 to 2.04), brain injury: 0.96 (0.55 to 1.69), respiratory complications: 5.97 (4.03 to 8.86), smoking history: 1.45 (0.99 to 2.13), traffic accident injury: 1.27 (0.92 to 1.74), and fall injury: 0.72 (0.52 to 1.01). Conclusions The current evidence shows that male sex, AIS A grade, AIS B grade, neurological level of injury (upper CSCI), high ISS, GCS≤8, thoracic injury, and respiratory complications are risk factors for tracheostomy after CSCI, and AIS C grade and AIS D grade are protective factors. This study will allow us to use these factors for tracheostomy decisions and ultimately optimize airway management in patients with CSCI.

show abstract

“…It is estimated that two-thirds of patients with SCI/D do not require ventilatory support after recovery from the acute injury and < 10% may require long-term ventilation. 39,40 However, there is increased risk of pulmonary complications, including delayed apnea in patients with high cervical SCI and more complete injuries. 41,42 Therefore, it may be prudent to consider early tracheostomy and ventilation in acute high cervical SCI (complete SCI above the level of C5) and noninvasive ventilation and assisted coughing techniques in lower cervical and thoracic level injuries.…”

Section: Management Of Sdb In Patients With Sci/dmentioning

confidence: 99%

Sleep-Disordered Breathing and Spinal Cord Injury

Sankari

Vaughan

Bascom

et al. 2019

Chest

View full text Add to dashboard Cite

Individuals living with spinal cord injury or disease (SCI/D) are at increased risk for sleep-disordered breathing (SDB), with a prevalence that is three-to fourfold higher than the general population. The main features of SDB, including intermittent hypoxemia and sleep fragmentation, have been linked to adverse cardiovascular outcomes including nocturnal hypertension in patients with SCI/D. The relationship between SDB and SCI/D may be multifactorial in nature given that level and completeness of injury can affect central control of respiration and upper airway collapsibility differently, promoting central and/or obstructive types of SDB. Despite the strong association between SDB and SCI/D, access to diagnosis and management remains limited. This review explores the role of SCI/D in the pathogenesis of SDB, poor sleep quality, the barriers in diagnosing and managing SDB in SCI/D, and the alternative approaches and future directions in the treatment of SDB, such as novel pharmacologic and nonpharmacologic treatments.

show abstract

What are the perspectives for ventilated tetraplegics? A French retrospective study of 108 patients with cervical spinal cord injury

Abstract: The conclusion of this work is that the future of highly tetraplegic patients is compromised, especially for those who remain reliant on mechanical ventilation.

Cited by 11 publications

References 17 publications

Predictors of respiratory complications in patients with C5–T5 spinal cord injuries

Predictors of respiratory complications in patients with C5–T5 spinal cord injuries

A Meta-Analysis of the Influencing Factors for Tracheostomy after Cervical Spinal Cord Injury

Sleep-Disordered Breathing and Spinal Cord Injury

Contact Info

Product

Resources

About