Full Length Article
Comparison of clinical outcomes of tracheotomy in patients with acute cervical spinal cord injury at different timing

https://doi.org/10.1016/j.clineuro.2021.106947Get rights and content
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Highlights

  • This study investigated the clinical outcomes of tracheotomy in CSCI patients at different timing.

  • Early to medium term tracheotomy exhibited shorter mechanical ventilation, lower ICU mortality, and lower pneumonia.

  • Early to medium term tracheotomy achieved better improvement of function outcomes at the follow-up.

  • This study found that the optimal timing of tracheotomy for CSCI patients may be within 10 days from initial intubation.

  • Further study is warranted to investigate the indication and risk factors of early tracheotomy in patients with CSCI.

Abstract

Respiratory failure is the leading cause of early death after acute CSCI. Tracheotomy is an effective approach to reduce mortality and improve the clinical outcomes. However, the optimal timing for tracheotomy remains controversial. Hence, the study aimed to compare the clinical outcomes of tracheotomy in patients with acute cervical spinal cord injury (CSCI) at different timing. A retrospectively review was performed of acute CSCI patients who underwent tracheotomy in the intensive care unit of Haian Hospital between January 2014 and June 2019. 124 CSCI patients were included and stratified into three groups based on the timing of tracheotomy: early group (≤4 days from initial intubation), medium group (4–10 days from initial intubation), and late group (≥10 days from initial intubation). The clinical outcomes and functional outcomes were analyzed. No significant intergroup differences in baseline characteristics were observed. The late group needed significantly longer duration of mechanical ventilation, longer ICU stay, and suffered higher ICU mortality, higher pneumonia after tracheotomy than the early and medium groups. More patients in the early and medium groups successfully weaned from mechanical ventilation. The early and medium groups achieved better improvement of JOA and NDI scores than the late group at one year after surgery and at the final follow-up. Early to medium term tracheotomy may lead to better clinical and functional outcomes in patients with acute CSCI who require prolonged mechanical ventilation.

Keywords

Cervical spine
Spinal cord injury
Tracheotomy
Optimal timing
Function

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