Cardiovascular Responses to Endotracheal Intubation in Patients with Acute and Chronic Spinal Cord Injuries

Yoo, Kyung Yeon; Bae, Hong Beom; Kim, Seok Jai; Lee, Hyung Kon; Choi, Jeong Il; Jeong, Seong Wook; Yoon, Myung Ha; Lim, Byong Do

Abstract

BACKGROUND: We investigated whether the cardiovascular responses to intubation change as a function of the time elapsed in patients with spinal cord injury.
METHODS
One hundred and fifty eight patients with traumatic complete spinal cord injury were grouped according to the time elapsed after injury (less than and more than 4 wks) and the level of injury (above C7, T1-T4, and below T5). There were six groups: acute quadriplegia (n = 28), chronic quadriplegia (n = 29), acute high paraplegia (n = 8), chronic high paraplegia (n = 11), acute low paraplegia (n = 29) and chronic low paraplegia (n = 53). Twenty-five patients with no spinal cord injury served as controls. Systolic arterial blood pressure (SAP), heart rate, and plasma concentrations of catecholamines were measured.
RESULTS
The intubation did not affect SAP in acute and chronic quadriplegics, but significantly increased SAP in the other groups. The magnitude of peak increase was less in acute high paraplegics (P<0.05), but comparable in chronic high paraplegics, and acute and chronic low paraplegics to that of the controls. Heart rates were significantly increased in all groups. However, the magnitude of this increase was smaller in acute quadriplegics and in acute high paraplegics than in the controls (P<0.05). Plasma concentrations of norepinephrine increased in all groups except in acute quadriplegics (P<0.05). The magnitude of this increase was attenuated in chronic quadriplegics, accentuated in acute low paraplegics, and similar in acute and chronic high paraplegics and in chronic low paraplegics versus the controls.
CONCLUSIONS
The cardiovascular and plasma catecholamine responses to endotracheal intubation may differ according to the time elapsed and the affected level in patients with complete spinal cord injuries.