Clinical introduction and benefits of non-invasive ventilation for above C3 cervical spinal cord injury.
Clinical introduction and benefits of non-invasive ventilation for above C3 cervical spinal cord injury. J Spinal Cord Med. 2019 Aug 12;:1-7 Authors: Toki A, Nakamura T, Nishimura Y, Sumida M, Tajima F Abstract STUDY DESIGN: Retrospective study. OBJECTIVES: To determine the best time to introduce non-invasive ventilation (NIV), clinical effectiveness of NIV, and complications of long-term use of NIV in patients with high-level cervical spinal cord injuries (CSCI). SETTING: Public Hospital, Japan. METHODS: The subjects were 14 tracheostomy ventilator-dependent patients, with above C3 spinal lesions, and American Spinal Cord Injury Association Impairment Scale A (ASIA A). They were referred to our clinic between 2005 and 2010 for switching mechanical ventilation support system from tracheostomy ventilation to NIV. Respiratory function tests were measured before and after NIV. Patients who were successfully switched to NIV were interviewed two years later and asked about their health and social status. RESULTS: Eleven patients were successfully switched to NIV. The success rate of switching to NIV within 1 year was also high (P
This report presents a novel technique termed the pharyngeal clearance maneuver, which uses a modified application of the mechanical insufflation-exsufflation device to mobilize “secretion burden” at the portion of the trachea above the tracheostomy cuff during cuff deflation. Utilization of this strategy may reduce the risk of aspiration, infection, and respiratory compromise for patients with high cervical spinal cord injury in the acute rehabilitation setting. It is of particular benefit for those whose cuffs are being deflated for the first time and who may have large secretion volumes above the cuff. It ca...
CONCLUSION: The high age of 60 years, combined facet dislocation, C4 level high, and ASIA A and B scale are indispensable to predict the need for tracheostomy in patients with CSCI at the acute stage. PMID: 31319757 [PubMed - in process]
CONCLUSION Use of the trach score identified the majority of patients requiring prolonged VS in our study. An early tracheostomy protocol using predictive modeling could aid in reduction of intensive care unit length of stay and improving ventilator weaning in these patients. External verification of this predictive tool and of an early tracheostomy protocol is needed. LEVEL OF EVIDENCE This work is a retrospective prognostic cohort study and meets evidence Level III criteria.
This article considers the extent of the damage being caused by this.
Analysis of the risk factors for tracheostomy and decannulation after traumatic cervical spinal cord injury in an aging population, Published online: 10 May 2019; doi:10.1038/s41393-019-0289-xAnalysis of the risk factors for tracheostomy and decannulation after traumatic cervical spinal cord injury in an aging population
CONCLUSIONS Diaphragm pacing system implantation in patients with acute CSCI can be one part of a comprehensive critical care program to improve outcomes. However, the association of DPS with the marked improved mortality seen on bivariate analysis may be due solely to improvements in critical care throughout the study period. Further studies to define the benefits of DPS implantation are needed. LEVEL OF EVIDENCE Therapeutic, level IV.
CONCLUSION Early tracheostomy within 4 days of ACF is safe without increased risk of infection compared with late tracheostomy. LEVEL OF EVIDENCE Evidence, level III.
CONCLUSION: The American Spinal Injury Association grade A, a radiological injury level of C5 and above, an MCC ≥50%, a lesion length ≥20 mm, and osteophyte formation at the level of injury were considered to be predictive values for requiring tracheostomy intervention in patients with cervical SCI. PMID: 30196655 [PubMed]
Regarding the letter sent by Agarwal et al, we would like to thank its authors for their comments and the opportunity we have been given to clarify certain points:
We read with avid interest the article by Galeiras et al.1 They conducted a retrospective, observational study of 56 patients who had been admitted to the intensive care unit with acute spinal cord injury (SCI) and who underwent a tracheostomy and surgical fixation. With this study they have made a commendable attempt at answering the question, “Wh at is the optimal timing to carry out a tracheostomy in a patient requiring anterior cervical fixation?” On the basis of their results, the authors concluded that the “presence of a tracheostomy stoma prior to, or immediately after surgery, is associated ...