< Tous les thèmes

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

Résumé Study Design Retrospective cohort study. Objectives To compare the proportion of tracheostomy placement and duration of mechanical ventilation (MV) in patients with a complete cervical spinal cord injury (SCI) that were managed early or lately in a specialized acute SCI-center. The second objective was to determine the impact of the timing of admission to the SCI-center on the MV support duration. Setting A single Level-1 trauma center specialized in SCI care in Quebec (Canada). Methods A cohort of 81 individuals with complete tetraplegia over a 6-years period was included. Group 1 (N = 57- early group-) was admitted before surgical management in one specialized acute SCI-center, whereas Group 2 (N = 24 -late group-) was surgically managed in a non-specialized center and transferred to the SCI center for post-operative management only. The proportion of tracheostomy placement and MV duration were compared. Multivariate regression analysis was used to assess the impact of the timing of admission to the SCI-center on the MV duration during the SCI-center stay. Results Patients in Group 2 had a higher proportion of tracheostomy (70.8 vs. 35.1%, p = 0.004) and a higher mean duration of MV support (68.0 ± 64.2 days vs. 21.8 ± 29.7 days, p = 0.006) despite similar age, trauma severity (ISS), neurological level of injury and proportion of pneumonia. Later transfer to the specialized acute SCI-center was the main predictive factor of longer MV duration, with a strong impact factor (s = 946.7, p < 0.001). Conclusions Early admission to a specialized acute SCI-center for surgical and peri-operative management after a complete tetraplegia is associated with lower occurrence of tracheostomy and shorter mechanical ventilation duration support. Sponsorship MENTOR Program of the Canadian Institute of Health Research and US Department of Defense Spinal Cord Injury Research Program.
AuteursAndréane Richard-Denis, Debbie Feldman, Cynthia Thompson, Martin Albert, Jean-Marc Mac-Thiong
Titre de revue/journal, volume et numéroSpinal Cord, volume 56.
Langue de la publication et/ou de traductionAnglais (langue d’origine)
Année de parution2018
PaysQuébec, Canada.
Institutions affiliéesHôpital Sacré-Coeur, Université de Montréal, Hôpital Ste Justine
Lien vers la publicationhttps://www.nature.com/articles/s41393-017-0003-9
Type d’accès à la publicationGratuit
Mots clés
Autres informations
* Décharge de responsabilité: MÉMO-Qc n’endosse pas la responsabilité des informations contenues dans les publications du répertoire de recherche.

Précédent The Functional Impact of the Absence of a Bulbocavernosus Reflex in the Postoperative Period After a Motor-Complete Traumatic Spinal Cord Injury
Prochain The relevance of MRI for predicting neurological recovery following cervical traumatic spinal cord injury
Table des matières