Risk Analysis Based on the Timing of Tracheostomy Procedures in Patients with Spinal Cord Injury Requiring Cervical Spine Surgery (original) (raw)
Related papers
Time to tracheostomy impacts overall outcomes in patients with cervical spinal cord injury
Journal of Trauma and Acute Care Surgery, 2020
BACKGROUND: The morbidity associated with cervical spine injury increases in the setting of concomitant cervical spinal cord injury (CSCI). A significant proportion of these patients require placement of a tracheostomy. However, it remains unclear if timing to tracheostomy following traumatic CSCI can impact outcomes. The aim of our study was to characterize outcomes associated with tracheostomy timing following traumatic CSCI. METHODS: We performed a 5-year (2010-2014) analysis of the American College of Surgeons Trauma Quality Improvement Program database and included all adult (age, ≥18 years) trauma patients who had traumatic CSCI and received tracheostomy. Patients were subdivided into two groups: early tracheostomy (ET) (≤4 days from initial intubation) and late tracheostomy (LT) (>4 days). Outcome measures included respiratory complications, ventilator-free days, intensive care unit-free days and hospital length of stay, and mortality. Multivariate logistic regression analysis was performed. RESULTS: A total of 5,980 patients were included in the study, of which 1,010 (17%) patients received ET, while 4,970 (83%) patients received LT. Mean age was 46 years, and 73% were men. In terms of CSCI location, 48% of the patients had high CSCI (C1-C4), while 52% had low CSCI (C5-C7). Patients in the ET group had lower rates of respiratory complications (30% vs. 46%, p = 0.01), higher ventilator-free days (13 days vs. 9 days; p = 0.02), intensive care unit-free days (11 days vs. 8 days; p = 0.01), and a shorter hospital length of stay (22 days vs. 29 days; p = 0.01) compared with those in the LT group. On regression analysis, ET was associated with lower rates of respiratory complications in patients with high CSCI (odds ratio, 0.55 [0.41-0.81]) and low CSCI (odds ratio, 0.93 [0.72-0.95]). However, no association was found between time to tracheostomy and in-hospital mortality. CONCLUSION: Early tracheostomy regardless of CSCI level may lead to improved outcomes. Quality improvement efforts should focus on defining the optimal time to tracheostomy and considering ET as a component of SCI management bundle.
Predicting the need for tracheostomy in patients with cervical spinal cord injury
The journal of trauma and acute care surgery, 2012
Approximately 75% of hospitalized patients with a cervical spinal cord injury (CSCI) will require intubation and mechanical ventilation (MV) because of compromised respiratory function. It is difficult to predict those CSCI patients who will require prolonged ventilation and therefore will most benefit from early tracheostomy. This study intended to show the benefits of tracheostomy, particularly early, and to identify predictors of prolonged MV after CSCI. A retrospective review of patients aged 16 years and older with acute CSCI admitted to London Health Science Center from 1991 to 2010 was performed. Demographic data and clinical parameters were extracted from medical records and the trauma registry. Regression analysis was used to identify predictors of prolonged MV. There were 66 eligible patients of which 42 (62%) had a tracheostomy performed. Five patients (7.6%) remained ventilator dependent and seven (10.6%) died more than 7 days after injury secondary to sepsis. After adju...
Tracheostomy after Anterior Cervical Spine Fixation
The Journal of Trauma: Injury, Infection, and Critical Care, 2004
Background: Patients with cervical spine injury may require both anterior cervical spine fusion and tracheostomy, particularly in the setting of associated cervical spinal cord injury (SCI). Despite the close proximity of the two surgical incisions, we postulated that tracheostomy could be safely performed after anterior spine fixation. In addition, we postulated that the severity of motor deficits in patients with cervical spine injury would correlate with the need for tracheostomy.
Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine, 2009
To assess outcomes in patients with spinal cord injury (SCI) and a tracheostomy tube (TT), before and after the introduction of a tracheostomy review and management service (TRAMS) for ward-based patients. Matched-pairs design with two cohorts, before and after the intervention. 900-bed tertiary hospital in Melbourne, Victoria. SCI patients with a TT that was removed: 34 patients in the post-TRAMS period (September 2003 to September 2006) were matched to 34 from the pre-TRAMS period (September 1999 to December 2001). TRAMS was introduced as a consultative team of specialist physicians, clinical nurse consultants, physiotherapists and speech pathologists. The team coordinated tracheostomy care, conducted twice-weekly rounds, and provided policy, education, and support. Comparison of length of stay (LOS), duration of cannulation (DOC), improved communication through use of a one-way valve, number of adverse events and related costs. Median patient LOS decreased from 60 days (interquar...
Global Spine Journal
Study design: Retrospective cohort study. Objective: Respiratory compromise (RC) is a rare but catastrophic complication of anterior cervical spine surgery (ACSS) commonly due to compressive fluid collections or generalized soft tissue swelling in the cervical spine. Established risk factors include operative duration, size of surgical exposure, myelopathy, among others. The purpose of this current study is to identify the incidence and clinical course of patients who develop RC, and identify independent predictors of RC in patients undergoing ACSS for cervical spondylosis. Methods: A large, prospectively-collected registry was used to identify patients undergoing ACSS for spondylosis. Patients with posterior cervical procedures were excluded. Baseline patient characteristics were compared using bivariate analysis, and multivariate analysis was employed to compare postoperative complications and identify independent predictors of RC. Results: 298 of 52,270 patients developed RC (inc...
Safety of early tracheostomy in trauma patients after anterior cervical fusion
The journal of trauma and acute care surgery, 2018
Cervical spine injuries (CSIs) can have major effects on the respiratory system and carry a high incidence of pulmonary complications. Respiratory failure can be due to spinal cord injuries, concomitant facial fractures or chest injury, airway obstruction, or cognitive impairments. Early tracheostomy (ET) is often indicated in patients with CSI. However, in patients with anterior cervical fusion (ACF), concerns about cross-contamination often delay tracheostomy placement. This study aimed to demonstrate the safety of ET within 4 days of ACF. Retrospective chart review was performed for all trauma patients admitted to our institution between 2001 and 2015 with diagnosis of CSI who required both ACF and tracheostomy, with or without posterior cervical fusion, during the same hospitalization. Thirty-nine study patients with ET (within 4 days of ACF) were compared with 59 control patients with late tracheostomy (5-21 days after ACF). Univariate and logistic regression analyses were perf...
2020
We report a 28 year old male with an unstable acute traumatic cervical spinal cord injury (SCI) due to anterior spondylolisthesis of C6 over C7 vertebra and facet joint dislocation of C6-C7 who underwent a successful bronchoscopy guided percutaneous tracheostomy (PCT) on day 6. Cervical SCI demands tracheostomy in majority but SCI with unstable cervical spine itself makes tracheostomy a challenging procedure. Even though cervical SCI was considered a relative contraindication for PCT, it can be safely performed in neutral neck position. Addition of ultrasound scanning of neck and bronchoscopic guidance further increases its safety profile. In cervical SCI early tracheostomy may be more effective than late.
Cervical spine clearance and neck extension during percutaneous tracheostomy in trauma patients
Critical Care Medicine, 2000
ercutaneous tracheostomy is performed in critical care units around the world with low morbidity and mortality (1-8). In many centers, including our own, it has become the procedure of choice in patients requiring elective tracheostomy (3, 6, 8-10). Specific advantages of percutaneous tracheostomy over conventional surgical tracheostomy are fewer complications including less bleeding and infection, improved scar appearance, decreased procedure time, and reduced cost (9, 11-13). Percutaneous tracheostomy can be performed at the bedside by nonsurgeons without a surgeon or anesthesiologist present (5, 6). The long-term results are believed to be at least equivalent to conventional surgical tracheostomy (4, 14, 15). Neck extension is generally recommended for tracheostomies, including percutaneous tracheostomy, because neck extension stretches the trachea and brings it closer to the skin surface (1, 5, 16). However, neck extension is contraindicated in trauma patients when cervical spine injury has not been completely excluded. In addition, neck extension may not be possible in patients with known cervical spine injury even if the spine has been stabilized surgically or with a halo brace because stabilization fixes the neck in a neutral or slightly flexed position. Consequently, trauma patients with uncleared necks or necks that may not be extended might be assumed to be poor candidates for percutaneous tracheostomy. The objective of this review was to determine the necessity of cervical spine clearance and neck extension for successful percutaneous tracheostomy in injured patients.