The need for early tracheostomy in patients with traumatic cervical cord injury
Traumatic spinal cord injuries (SCI) are a common cause of death and disability. These injuries can cause multiple organ failure or complications, irreversible paralysis, and respiratory failure. Many patients with respiratory dysfunction cannot breathe without assistance and require mechanical ventilation. Endotracheal intubation, in which a breathing tube is inserted through the mouth or nose, is typically a safe method for mechanical ventilation. This method can be inefficient and may cause serious discomfort. Tracheostomy, in which a breathing tube is surgically inserted directly into the windpipe, can make breathing more comfortable and reduce respiratory complications in patients with SCI. However, this method is considered an invasive procedure, and there is controversy about proper timing of tracheostomy in trauma patients.
Korean researchers investigated the criteria and timing of tracheostomy in SCI patients who need mechanical ventilation. Using the American Spinal Injury Association (ASIA) impairment scale score and other clinical parameters, they compared outcomes in SCI patients who received tracheostomy at different time points in the post-injury period.
They determined that patients who did receive a tracheostomy showed more impairment according to the ASIA impairment scale, compared to patients who only received endotracheal intubation. This indicates that tracheostomy is necessary when injury-related impairment is significant. The researchers also found that patients who received an early tracheostomy remained in the intensive care unit for an average of 11.4 days, while those who received a late tracheostomy needed 19.7 days.
Tracheostomy may be necessary when functional impairment is high or when certain areas of the spine (above the C4) are injured. For SCI patients who do need a tracheostomy, early intervention can significantly decrease the length of their hospitalization and may have a positive effect on overall prognosis. Because tracheostomy is an invasive procedure, clinicians are advised to consider relevant criteria before choosing this type of mechanical ventilation for patients.
Beom JY & Seo HY. The need for early tracheostomy in patients with traumatic cervical cord injury. Clinics in Orthopedic Surgery. (June 2018).