Critical Care Management of Acute Spinal Cord Injury—Part II: Intensive Care to Rehabilitation

Abstract

Spinal cord injury is devastating to those affected due to the loss of motor and sensory function, and, in some cases, cardiovascular collapse, ventilatory failure, and bowel and bladder dysfunction. Primary trauma to the spinal cord is exacerbated by secondary insult from the inflammatory response to injury. Specialized intensive care of patients with acute spinal cord injury involves the management of multiple systems and incorporates evidence-based practices to reduce secondary injury to the spinal cord. Patients greatly benefit from early multidisciplinary rehabilitation for neurologic and functional recovery. Treatment of acute spinal cord injury may soon incorporate novel molecular agents currently undergoing clinical investigation to assist in neuroprotection and neuroregeneration.

Critical Care Management of Fracture Dislocation of Cervical Spine: A Case Report

“…9 Early tracheostomy (less than seven days after injury) may help wean patients who tend to require prolonged mechanical ventilation, decreasing the length of stay and reducing laryngotracheal complications. 11 The intercostal muscles are initially flaccid if the spinal cord injury is treated correctly. Gastric stress ulceration is common in patients with cervical injuries, possibly due to secondary causes or impaired innervation.…”

“…7Neurogenic shock is a condition of concern in spinal cord injuries, and the triad includes hypotensionintravascular volume and cardiac preload, stimulating atrial stretch receptors, which respond to reduced parasympathetic tone, increasing heart rate. In shock patients, vasopressors and inotropes are administered to stabilize blood pressure and reduce ischemia in the nerves 11. Injury to the cervical and resulting dysfunction of the sympathetic nerves, characterized by bradycardia and neurogenic shock, hypotension that occurs can also cause hypoperfusion injury to the cord.…”