Sepsis in mechanically ventilated patients with spinal cord injury: a retrospective analysis

Abstract

Study Design Retrospective analysis. Objectives Sepsis, one of the most frequent and life-threatening complications on intensive care units (ICUs), is associated with a need for mechanical ventilation (MV) as well as adverse respiratory outcomes in hospitalized individuals. However, it has poorly been investigated in patients with spinal cord injury (SCI); a population at high risk for pulmonary and infectious complications. Setting Spinal Cord Injury Center, Heidelberg University Hospital. Methods Over a 5-year period, 182 individuals with SCI requiring MV during their ICU stay were analyzed. Data assessment included demographics, medical characteristics, focus and causative pathogen of sepsis, length of stay, weaning outcomes, and mortality. Results Sepsis was recorded in 28 patients (15%), containing a subgroup of individuals suffering from infectious SCI and co-occurring primary sepsis with Staphylococcus aureus as the predominant microorganism. In most individuals, sepsis was found as secondary complication, which was associated with pulmonary foci, Gram-negative bacteria, and high mortality. More than 80% of individuals with secondary sepsis required induction of MV due to respiratory failure. Furthermore, respiratory failure was found to be independent of sepsis focus, spectrum of causative pathogens, SCI etiology, or severity of injury. Subsequent weaning from the respirator was prolonged in more than 90% with a high proportion of weaning failure. Conclusions Sepsis predominantly occurs as a secondary complication after SCI and is associated with detrimental outcomes. Although the lung is frequently affected as a failing organ, not all sepsis foci are pulmonary. Awareness of both actual sepsis focus and causative pathogen is central to initiate an adequate sepsis treatment.

Discharge prediction of critical patients with spinal cord injury: a machine learning study with 1485 cases

“…There is a paucity of research on the clinical outcomes of SCI patients who require ICU care [4], [8], [30][31][32]. The mortality rate of critical SCI patients was about 10% in the current study, but other reported the mortality rate could reach 38.5% [33].…”

“…More importantly, critical SCI patients may suffer from a higher mortality due to renal failure, respiratory failure, hemodynamic instability, sepsis from urinary tract infection, life-threatening autonomic hyper-reflexia etc. [3][4][5][6][7][8] . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.…”

“…More importantly, critical SCI patients may suffer from a higher mortality due to renal failure, respiratory failure, hemodynamic instability, sepsis from urinary tract infection, life-threatening autonomic hyper-reflexia etc. [3][4][5][6][7][8] Prognostication plays an important part in clinical practice, which can contribute to the decision-making of clinical management for doctors and assist the communication with the patients and their families. For critical patients in the intensive care unit (ICU), discharge destination may be one of the most important concerns [9], [10].…”

Pharmacological and non-pharmacological therapeutic interventions for the treatment of spinal cord injury-induced pain

“…In addition to unrelenting visceral pain, neurogenic bowel can be particularly disadvantageous to patient welfare given that complications of neurogenic bowel (i.e., autonomic dysreflexia, septicemia, etc.) account for the most prevalent causes of emergency medical treatment during the chronic stage of SCI care ( 26 – 29 ).…”

High tidal volume ventilation is associated with ventilator-associated pneumonia in acute cervical spinal cord injury

“…VAP increases the need for prolonged mechanical ventilation and worsens neurologic recovery, which lead to increased long-term ventilator dependence. 7,8 People with SCI surviving to one-year post injury who are ventilator dependent have approximately half the life expectancy of similarly injured individuals who are not ventilator dependent. 9 Few ventilator management strategies aiming to decrease the duration of ventilator dependence have been evaluated in SCI patients, both in the acute and sub-acute rehabilitation settings.…”