Characterizing the need for mechanical ventilation following cervical spinal cord injury with neurologic deficit
Characterizing the need for mechanical ventilation following cervical spinal cord injury with neurologic deficit
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DOI：
10.1097/01.ta.0000187660.03742.a6
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发表时间：
2005-10-01
影响因子：
--
通讯作者：
Scalea, TM
中科院分区：
文献类型：
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作者：
Como, JJ;Sutton, ERH;Scalea, TM
背景：伴有神经功能缺损的颈脊髓损伤（C-SCI）患者可能需要明确气道和/或延长机械通气时间。本研究的目的是表征与C-SCI患者呼吸衰竭和/或需要机械通气的高风险相关的因素。方法：回顾性分析2000年7月1日至2002年6月30日在一级创伤中心收治的C-SCI合并神经功能缺损患者的人口统计学特征、神经功能缺损的程度和完全性、最终气道的需要、气管切开术的需要、出院时机械通气的需要（MVDC）和预后。损伤的程度和完整性由美国脊髓损伤协会标准确定。结果：在此期间发现了119例C-SCI和神经功能缺损患者。其中，45例被确定为完全C-SCI: 12例（27%）患者有Cl至C4水平；C5水平19例（42%）；14人（31%）的C6及以下水平。男性37例，女性8例。有36处钝器伤，9处穿透伤。患者的平均年龄为40+/-21岁，平均ISS为45+/-22岁。8例完全性C-SCI患者死亡，死亡率为18%。在37名幸存者中，92%接受了明确的气道，81%接受了气管切开术，51%需要MVDC。所有C5级及以上完全损伤的患者都需要明确的气道和气管切开术，71%的幸存者需要MVDC。在C6及以下完全损伤的患者中，79%接受了明确的气道，50%需要气管切开术，15%的幸存者需要MVDC。只有35%的不完全性损伤需要明确的气道，只有7%需要气管切开术。结论：明确气道控制、气管造口术和呼吸机依赖的必要性是显著的，特别是对于高度完全性C-SCI患者。基于这些结果，我们建议完全性C-SCI患者考虑早期插管和气管切开术，特别是对于C5及以上水平的患者。
Background: Patients who sustain cervical spinal cord injury (C-SCI) with neurologic deficit may require a definitive airway and/or prolonged mechanical ventilation. The purpose of this study was to characterize factors associated with a high risk for respiratory failure and/or the need for mechanical ventilation in C-SCI patients.Methods: Patients with C-SCI and neurologic deficit admitted to a Level I Trauma Center between July 1, 2000 and June 30, 2002 were retrospectively reviewed for demographics, level and completeness of neurologic deficit, need for definitive airway, need for tracheostomy, need for mechanical ventilation at hospital discharge (MVDC), and outcomes. The level and completeness of injury were defined by American Spinal Injury Association standards.Results: One hundred nineteen patients with C-SCI and neurologic deficit were identified over this period. Of these, 45 were identified as complete C-SCI: 12 (27%) patients had levels of Cl to C4; 19 (42%) had a level of C5; and 14 (31%) had levels of C6 and below. There were 37 males and 8 females. There were 36 blunt and 9 penetrating injuries. The average age of these patients was 40+/-21, and the average ISS was 45+/-22. Eight of the patients with complete C-SCI died, for a mortality of 18%. Of the 37 survivors, 92% received a definitive airway, 81% received tracheostomy, and 51% required MVDC. All patients with complete injuries at the C5 level and above required a definitive airway and tracheostomy, and 71% of survivors required MVDC. Of the patients with complete injuries of C6 and below, 79% received a definitive airway, 50% required tracheostomy, and 15% of survivors required MVDC. Only 35% of incomplete injuries required a definitive airway, and only 7% required tracheostomy.Conclusions: The need for definitive airway control, tracheostomy, and ventilator dependence is significant, especially for patients with high complete C-SCI. Based on these results we recommend consideration of early intubation and tracheostomy for patients with complete C-SCI, especially for those with levels of C5 and above.