Tracheostomy timing in traumatic spinal cord injury.
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.
Romero
Javier
J
Intensive Care Unit and Neurology Unit, UCI, Hospital Nacional de Paraplejicos, Finca La Peraleda s/n, 45071, Toledo, Spain. fjromero@sescam.jccm.es
Vari
Alessandra
A
Gambarrutta
Claudia
C
Oliviero
Antonio
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D012133:Respiratory Paralysis / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000150:complications*; D013997:Time Factors; D014132:Trachea / Q000293:injuries / Q000473:pathology / Q000601:surgery; D014135:Tracheal Stenosis / Q000209:etiology; D014139:Tracheostomy / Q000379:methods* / Q000592:standards; D016896:Treatment Outcome; D055815:Young Adult