Risk Analysis Based on the Timing of Tracheostomy Procedures in Patients with Spinal Cord Injury Requiring Cervical Spine Surgery

Galeiras, Rita; Mourelo, Mónica; Bouza, María Teresa; Seoane, María Teresa; Ferreiro, María Elena; Montoto, Antonio; Salvador, Sebastián; Seoane, Leticia; Freire, David

doi:10.1016/j.wneu.2018.05.065

Cited by 13 publications

(13 citation statements)

References 12 publications

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“…Mortality in this study was measured at 1 year and thus considered a long-term outcome; other than the study performed by Babu et al, which measured mortality at 1 year for the total study population, this was the only study to report long-term mortality [24]. Only 1 study reported duration of sedation and found that there was no signi cant difference for patients who underwent early versus late tracheostomy (14.4 + 10.4 days vs. 10.5 + 7.1 days, respectively, p = 0.283) [25]. The same study also found that timing of tracheostomy did not affect time to initiation of oral nutrition [25].…”

Section: Qualitative Assessment Of Additional Secondary Outcomesmentioning

confidence: 84%

“…The characteristics of included studies are summarized in Table 1. Studies differed in their de nitions of early and late tracheostomy (Supplemental Appendix 6), although the majority utilized a range of <7 days (from either injury, intubation, or surgery) for early tracheostomy [23][24][25][26][27][28][29][30][31][32][33]. In one study, early and late tracheostomy were de ned as <7 days and >7 days, respectively, but the time point from which tracheostomy was measured was not speci ed [34].…”

Section: Study Characteristics and Methodological Qualitymentioning

confidence: 99%

“…Future research could look more speci cally at quality of life (QOL) or other patient-reported outcome measures following tracheostomy in patients with SCI. One study included in this systematic review investigated QOL outcomes and found that the number of days until initiation of oral nutrition was not signi cantly different between the early and late tracheostomy group [25]. A prior study examining dysphagia in SCI patients found that those patients without dysphagia experienced a mean orotracheal intubation duration prior to tracheostomy of 10.0 days, versus 16.9 days for those with dysphagia [59].…”

Section: Multiple Factors May Contribute To the Lack Of Consensus Regarding The Timing Of Tracheostomy In Patients With Acute Sci The Necmentioning

confidence: 99%

“…Only 1 study reported duration of sedation and found that there was no signi cant difference for patients who underwent early versus late tracheostomy (14.4 + 10.4 days vs. 10.5 + 7.1 days, respectively, p = 0.283) [25]. The same study also found that timing of tracheostomy did not affect time to initiation of oral nutrition [25]. Vitaz et al found that implementation of a clinical pathway, including the placement of a tracheostomy approximately 4 days following injury, was associated with a decreased number of both decubitus ulcers and stage III ulcers (25% and 0%, respectively, in the clinical pathway group compared to 54% and 14%, respectively, in the control group) [33].…”

Section: Qualitative Assessment Of Additional Secondary Outcomesmentioning

confidence: 99%

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Timing of tracheostomy in acute traumatic spinal cord injury: a systematic review and meta-analysis

Foran

Taran

Singh

et al. 2021

Preprint

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Background Patients with acute traumatic cervical or high thoracic level spinal cord injury (SCI) typically require mechanical ventilation (MV) during their acute admission. Placement of a tracheostomy is preferred when prolonged weaning from MV is anticipated. However, the optimal timing of tracheostomy placement in patients with acute traumatic SCI remains uncertain. We systematically reviewed the literature to determine the effects of early versus late tracheostomy or prolonged intubation in patients with acute traumatic SCI on important clinical outcomes.Methods Six databases were searched from their inception to January 2020. Conference abstracts from relevant proceedings and the gray literature were searched to identify additional studies. Data was obtained by two independent reviewers to ensure accuracy and completeness. The quality of observational studies was evaluated using the Newcastle Ottawa Scale (NOS).Results Seventeen studies (2,804 patients) met selection criteria, 14 of which were published after 2009. Meta-analysis showed that early tracheostomy was not associated with decreased short-term mortality (risk ratio [RR] 0.84; 95% confidence interval [CI] 0.39 to 1.79; p = 0.65; n = 2,072), but was associated with a reduction in MV duration (mean difference [MD] 13.1 days; 95% CI -6.70 to -21.11; p = 0.0002; n = 855), intensive care unit (ICU) length of stay (MD -10.20 days; 95% CI -4.66 to -15.74; p = 0.0003; n = 855), and hospital length of stay (MD -7.39 days; 95% CI -3.74 to -11.03; p < 0.0001; n = 423). Early tracheostomy was also associated with a decreased incidence of ventilator-associated pneumonia (VAP) and tracheostomy-related complications (RR 0.86; 95% CI 0.75 to 0.98; p = 0.08; n = 2,043 and RR 0.08; 95% CI -0.01 to -0.15; p = 0.02; n = 812 respectively). The majority of studies ranked as good methodologic quality on the NOS. Conclusions Early tracheostomy in patients with acute traumatic SCI may reduce duration of mechanical ventilation, length of ICU stay, and length of hospital stay. Current studies highlight the lack of high-level evidence to guide the optimal timing of tracheostomy in acute traumatic SCI. Future research should seek to understand whether early tracheostomy improves patient comfort, decreases duration of sedation and improves long-term outcomes.PROSPERO registration number: CRD42020162488

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Section: Qualitative Assessment Of Additional Secondary Outcomesmentioning

confidence: 84%

Section: Study Characteristics and Methodological Qualitymentioning

confidence: 99%

Section: Multiple Factors May Contribute To the Lack Of Consensus Regarding The Timing Of Tracheostomy In Patients With Acute Sci The Necmentioning

confidence: 99%

Section: Qualitative Assessment Of Additional Secondary Outcomesmentioning

confidence: 99%

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Timing of tracheostomy in acute traumatic spinal cord injury: a systematic review and meta-analysis

Foran

Taran

Singh

et al. 2021

Preprint

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“…Tracheostomy placement both prior to and immediately Critical Care Management of Acute Spinal Cord Injury Sacino, Rosenblatt after anterior cervical spine surgery has been shown to be safe and does not increase the risk of surgical wound infection. 42,43 Success in remaining without invasive airway support varies in patients with injuries from C3 to C6. Early tracheostomy (less than 7 days after injury) has a clear benefit in patients who are likely to require prolonged mechanical ventilation, such as shorter length of ICU stay and decreased laryngotracheal complications.…”

Section: Respiratorymentioning

confidence: 99%

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

Sacino

Rosenblatt

2019

Journal of Neuroanaesthesiology and Critical Care

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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.

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Percutaneous dilational tracheostomy following anterior cervical spine fixation – a retrospective propensity-matched cohort study

Meisterfeld,

Queck,

Disch

et al. 2024

Eur Spine J

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Purpose In patients with traumatic, infectious, degenerative, and neoplastic surgical indications in the cervical spine, commonly the anterior approach is used. Often these patients require a tracheostomy necessary due to prolonged mechanical ventilation. The limited spinal mobility and proximity to the surgical site of anterior cervical spine fixation (ACSF) could pose an increased risk for complications of percutaneous dilational tracheostomy (PDT.) Importantly, PDT might raise wound infection rates of the cervical spine approach. The aim of this study is to prove safety of PDT after ACSF. Methods We performed a retrospective, single-center study comparing patients with and without ACSF who underwent Ciaglia-single step PDT. After propensity score matching using logistic regression, we compared intra- and postprocedural complication rates. Furthermore, surgical site infections were evaluated. Putensen’s definitions of complications and Clavien-Dindo’s classification were used. Results A total of 1175 patients underwent PDT between 2009 and 2021. Fifty-seven patients underwent PDT following ACSF and were matched to fifty-seven patients without ACSF. The mean interval between ACSF and PDT was 11.3 days. The overall complication rate was 19.3% in the ACSF group and 21.1% in the non-ACSF group. The mean follow-up was 388 days (± 791) in the ACSF group and 424 days (± 819) in the non-ACSF group. Life-threatening complications (Clavien-Dindo IV to V) were found in 1.8% of ACSF patients and 3.5% of non-ACSF patients. There were no significant differences in complication rates. No surgical site infection of the anterior spine access was detected. Conclusion PDT is a feasible and safe procedure in patients after ACSF. Complication rates are comparable to patients without ACSF. Surgical site infections of ACSF are very rare.

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Risk Analysis Based on the Timing of Tracheostomy Procedures in Patients with Spinal Cord Injury Requiring Cervical Spine Surgery

Cited by 13 publications

References 12 publications

Timing of tracheostomy in acute traumatic spinal cord injury: a systematic review and meta-analysis

Timing of tracheostomy in acute traumatic spinal cord injury: a systematic review and meta-analysis

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

Percutaneous dilational tracheostomy following anterior cervical spine fixation – a retrospective propensity-matched cohort study

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