The impact of a specialized spinal cord injury center as compared with non-specialized centers on the acute respiratory management of patients with complete tetraplegia: an observational study

Abstract

MENTOR Program of the Canadian Institute of Health Research and US Department of Defense Spinal Cord Injury Research Program.

Separation from mechanical ventilation and survival after spinal cord injury: a systematic review and meta-analysis

“…Six studies were multicentric [ 30 – 35 ], 33 were conducted at a single site [ 8 , 12 , 36 – 66 ]. Most studies were conducted either in Level I [ 8 , 37 , 42 , 46 , 57 , 61 , 63 , 66 ] or in unspecified trauma/SCI treatment centers [ 12 , 31 , 35 , 36 , 38 , 39 , 41 , 43 , 47 , 48 , 50 – 52 , 55 , 59 , 62 , 65 ]. Twenty-five studies were run in ICUs [ 12 , 30 – 33 , 35 – 44 , 46 , 57 , 59 – 62 , 64 – 66 ], 14 in rehabilitative settings [ 34 , 45 , 47 – 56 , 58 , 61 ] (Additional file 1 : Table S1).…”

“…Most studies were conducted either in Level I [ 8 , 37 , 42 , 46 , 57 , 61 , 63 , 66 ] or in unspecified trauma/SCI treatment centers [ 12 , 31 , 35 , 36 , 38 , 39 , 41 , 43 , 47 , 48 , 50 – 52 , 55 , 59 , 62 , 65 ]. Twenty-five studies were run in ICUs [ 12 , 30 – 33 , 35 – 44 , 46 , 57 , 59 – 62 , 64 – 66 ], 14 in rehabilitative settings [ 34 , 45 , 47 – 56 , 58 , 61 ] (Additional file 1 : Table S1). In 8 studies the cause of the injury was not specified [ 33 , 43 , 47 , 49 , 51 , 53 , 54 , 58 ], all the remaining studies enrolled traumatic SCI patients, 2 of them [ 55 , 61 ] enrolled both traumatic and a few non-traumatic patients, whose outcomes were not separable.…”

“…The majority of the studies did not mention the use of any weaning protocol [ 8 , 12 , 31 , 33 , 34 , 42 , 47 , 49 , 52 , 57 , 61 ]; two studies mentioned the use of a protocol without specifying it [ 48 , 64 ]. For the remaining 10 studies, the most frequently weaning protocol was a progressive increase in ventilator-free breathing, with mild variations among the studies, including unassisted breathing until tired or graded time off the ventilator [ 45 , 50 , 58 , 65 ]; unassisted breathing alternated to periods of intermittent mandatory ventilation, continuous positive airway pressure [ 43 ] or pressure support ventilation [ 46 , 51 , 56 ]; non-invasive ventilation with the tracheostomy sealed [ 53 – 56 ]. Only 2 studies provided information on the number of patients requiring one/two or more than two weaning attempts [ 16 , 65 ], and only 3 studies reported the number of patients failing extubation [ 31 , 57 , 65 ].…”

“…The application of rehabilitation protocols was mentioned in 5 studies and involved respiratory and physical rehabilitation [ 46 , 56 , 60 ], respiratory therapy [ 65 ] and respiratory muscle training [ 45 ].…”

Early Management of Acute Spinal Cord Injury—Part I: Initial Injury to Surgery

“…8,9 These advances have likely played a role in both improved early survival and a decrease in incidence of severe (complete) SCI relative to incomplete SCI. 10,11 Developed countries such as the United States, Finland, and Australia are seeing greater percentages of incomplete quadriplegia from high cervical SCIs than in the past. [12][13][14] This trend is thought to be attributed to advances in early resuscitation and rapid airway management for an increasingly older population experiencing falls.…”