Pulmonary complications of acute spinal cord injuries.
The records of 123 consecutive patients admitted with spinal cord injury were examined for the presence of pulmonary complications. Forty-nine had tetraplegia and 23 had paraplegia; the remainder suffered a variety of neurological deficits. Multiple injuries were encountered in 36 patients. Fifty-three pulmonary complications were noted in 44 (35.7%) patients. The most common problems were atelectasis and pneumonia. There were 22 (18%) deaths. Fourteen deaths were related to pulmonary complications. The mean age of patients who died was 52 +/- 13 (SE) compared to 28 +/- 12 for survivors. A mean forced vital capacity (FVC) of 1127 +/- 410 cc in patients suffering respiratory difficulties compared to a FVC of 1865 +/- 85 cc in patients without complications (P less than 0.001). Oxygenation (PaO2 90 +/- 19 torr) was normal in patients without respiratory problems and was abnormal in patients developing problems (PaO2 76 +/- 30 torr; P less than 0.05). Twenty patients were treated with a rotating bed. The complication rate of patients on the bed was only 10%. In conclusion, respiratory problems remain a significant cause of morbidity and mortality in spinal cord injury. The forced vital capacity, blood oxygen tension, and age are predictors of pulmonary complications. The use of a multidisciplinary approach and a rotating bed may minimize these problems.
Reines
H D
HD
Medical University of South Carolina, Charleston.
Harris
R C
RC
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D001261:Pulmonary Atelectasis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D013119:Spinal Cord Injuries / Q000150:complications*