Respiratory management of pediatric patients with spinal cord injuries: retrospective review of the duPont experience.
Pulmonary complications contribute to morbidity and mortality in spinal cord injuries (SCIs). A retrospective review of 20 years of experience with tracheostomy- and ventilator-dependent SCI children is presented. The authors developed and analyzed a database of 47 children (average age = 11.4 years). Of the patients, 27% had concomitant brain injuries, 6% had prior histories of reactive airway disease, and 2% had thoracic fractures. Injuries were caused by motor vehicle accidents (53%); gunshot wounds (19%); sports-related accidents (19%); and vascular injuries, transverse myelitis, or spinal tumors (8%). Of the injuries, 52% were high level (C1 to C2) and 48% were mid- or low level (C3 to C5). Two groups were analyzed for demographic information. Complications included tracheitis, atelectasis, and pneumonia. Mean tidal volume was 14 cm2/kg (maximum = 22 cm2/kg). Bedside lung function parameters were attempted to assess readiness and the rapidity of weans. T-piece sprints were used to successfully wean 63% of patients. Successfully weaned patients were compared with those not weaned. No deaths or readmissions for late-onset respiratory failure postwean occurred. The authors' clinical impression favors higher tidal volumes and aggressive bronchial hygiene to minimize pulmonary complications and enhance weaning. Successfully weaned patients had fewer complications. A critical pathway for respiratory management of SCI children is presented.
Padman
Raj
R
Division of Pulmonology Medicine, Nemours Children's Clinic-Wilmington, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA. rpadman@nemours.org
Alexander
Michael
M
Thorogood
Christine
C
Porth
Susan
S
D000293:Adolescent; D002648:Child; D006801:Humans; D010351:Patient Discharge; D012121:Respiration, Artificial; D015656:Respiratory Mechanics; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications / Q000534:rehabilitation* / Q000628:therapy*; D014139:Tracheostomy; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000379:methods*