Tracheostomy timing in traumatic spinal cord injury

Abstract

The study conducted is the retrospective study and the main objective is to evaluate the benefits and safety of early versus late tracheostomy in traumatic spinal cord injury (SCI) patients requiring mechanical ventilation. Tracheostomy offers many advantages in critical patients who require prolonged mechanical ventilation. Despite the large amount of patients treated, there is still an open debate about advantages of early versus late tracheostomy. Early tracheostomy following the short orotracheal intubation is probably beneficial in appropriately selected patients. It is a retrospective clinical study and we evaluated clinical records of 152 consecutive trauma patients who required mechanical ventilation and who received tracheostomy. The results show that the early placement (before day 7 of mechanical ventilation) offers clear advantages for shortening of mechanical ventilation, reducing ICU stay and lowering rates of severe orotracheal intubation complication, such as tracheal granulomas and concentric tracheal stenosis. On the other hand, we could not demonstrate that early tracheostomy avoids neither risk of ventilator-associated pneumonia nor the mortality rate. In SCI patients, the early tracheostomy was associated with shorter duration of mechanical ventilation, shorter length of ICU stay and decreased laryngotracheal complications. We conclude by suggesting early tracheostomy in traumatic SCI patients who are likely to require prolonged mechanical ventilation.

The acute respiratory management of cervical spinal cord injury in the first 6 weeks after injury: a systematic review

“…These authors reported that tracheostomy insertion as early as day 4 post anterior cervical stabilization did not appear to pose a risk of cross infection. Another case series 38 showed that tracheostomy inserted before day 7 reduced the duration of mechanical ventilation and ICU length of stay.…”

“…Overall, there was limited evidence to support the use of NIV to reduce the duration of mechanical ventilation. 31 One case series 38 reported that tracheostomy timing either before or after day 7 was independently associated with duration of mechanical ventilation.…”

Tracheostomy: Epidemiology, Indications, Timing, Technique, and OutcomesDiscussion

“…A retrospective cohort study compared 71 SCI subjects with early tracheostomy (within 7 d) with 81 similar subjects who received late tracheostomy (after 7 d) and found decreased ICU days, ICU days after tracheostomy, ventilator days, and ventilator days after tracheostomy in the early tracheostomy cohort, but no differences in hospital mortality and rates of VAP were identified. 68 Ganuza et al 69 retrospectively compared 101 SCI subjects with early tracheostomy (Ͻ 7 d) with 114 subjects with late tracheostomy (Ն 7 d) and found decreased ventilator days, ICU days, and rates of tracheal stenosis, but no differences in rates of pneumonia, stomal cellulitis, or hospital mortality. As with other specialized patient populations, large prospective randomized trials are warranted in this area.…”

Electrophrenic pacing and decannulation for high-level spinal cord injury: A case series

“…12 However, no such publications indicate how to use full NVS and MAC to avoid intubation. [13][14][15][16][17] Once intubated, no publications discuss extubation of 'unweanable' patients to NVS. 3,4,6,8,12 The general recommendation is that following three or more failed spontaneous breathing trials the patient be considered a 'prolonged weaning patient' and undergo tracheotomy.…”

“…3,4,6,8,12 The general recommendation is that following three or more failed spontaneous breathing trials the patient be considered a 'prolonged weaning patient' and undergo tracheotomy. [13][14][15][16] This is true despite the fact that even 'unweanable' patients with functioning bulbar musculature can usually be extubated to NVS and may subsequently wean themselves. 17 Further, without explaining NVS, convention has it that This occurs despite the cost and quality of life benefits of using long-term NVS rather than invasive management 18 and that noninvasive management permits patients to master GPB for security in the event of ventilator/device failure.…”