Clin Orthop Surg.  2018 Jun;10(2):191-196. 10.4055/cios.2018.10.2.191.

The Need for Early Tracheostomy in Patients with Traumatic Cervical Cord Injury

• Beom JY
• Seo HY

• KMID: 2411744
• DOI: http://doi.org/10.4055/cios.2018.10.2.191

Abstract

BACKGROUND
In patients who need sustained endotracheal intubation and mechanical ventilation due to respiratory failure after traumatic cervical spinal cord injury, tracheostomy can be performed to reduce the duration of mechanical ventilation and respiratory complications. The purpose of this study was to determine criteria and timing of tracheostomy in patients with severe traumatic cervical spinal cord injury accompanied by motor weakness.
METHODS
We reviewed 22 patients who underwent tracheostomy (study group) and 27 patients who did not (control group) from January 2005 to March 2016. We assessed the American Spinal Injury Association (ASIA) impairment scale score and investigated accompanying thoracic injury, paradoxical respiration, postoperative endotracheal intubation and other clinical parameters. The study group was also subdivided into the early tracheostomy group and late tracheostomy group depending on whether the tracheostomy was performed within or later than 7 days after surgery.
RESULTS
Twenty-two patients in the study group had a mean ASIA impairment scale score of 14.1 points, which was lower than the control group's 23.4 points. Paradoxical respiration was observed in 77% of the patients in the study group compared to 18% in the control group. Postoperative intubation was maintained in 68% in the study group; 32% underwent endotracheal intubation due to respiratory failure within 4 days after surgery and had a tracheostomy. In the control group, postoperative intubation was maintained in 22%, and all of them were weaned off intubation within 4 days after surgery. The duration of intensive care unit hospitalization was 11.4 days for the early tracheostomy group, which was shorter than the late tracheostomy group's 19.7 days.
CONCLUSIONS
In patients with severe traumatic cervical spinal cord injury, tracheostomy may be needed when the motor grade of the ASIA scale is low, above the C4 segment is injured, or paradoxical respiration occurs after injuries. In addition, if endotracheal extubation is not feasible within 4 days after surgery, an early tracheostomy should be considered.

Keyword

Traumatic cervical cord injury; Early tracheostomy; Paradoxical respiration

MeSH Terms

Airway Extubation
Asia
Cervical Cord*
Hospitalization
Humans
Intensive Care Units
Intubation
Intubation, Intratracheal
Respiration
Respiration, Artificial
Respiratory Insufficiency
Spinal Injuries
Thoracic Injuries
Tracheostomy*

Figure

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  Fig. 1 Injury level in tracheostomy and non-tracheostomy patients.

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  Fig. 2 (A) Duration until postoperative intubation in tracheostomy patients: intubation was required in all patients until postoperative day (POD) 4. (B) Duration until extubation in non-tracheostomy patients: extubation was performed within POD 4. OP: operative.

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