title: The acute respiratory management of cervical spinal cord injury in the first 6 weeks after injury: a systematic review.
abstract: METHODS
  Systematic review.
  
  
  OBJECTIVE
  Identify, evaluate, and synthesize evidence regarding the effectiveness of various treatment strategies for the respiratory management of acute tetraplegia.
  
  
  METHODS
  Melbourne, Australia.
  
  
  METHODS
  A search of multiple electronic databases (Medline, Cinahl, EMBASE, Cochrane Library, Web of Science, http://www.guideline.gov and http://www.icord.org/scire) was undertaken accompanied by the reference lists of all relevant articles identified. Methodological quality was assessed using the Newcastle-Ottawa Scale and the PEDro Scale. Descriptive analysis was performed.
  
  
  RESULTS
  Twenty-one studies including 1263 patients were identified. The majority of the studies were case series (n = 13). A variety of interventions were used for the management of respiratory complications. Mortality (ARR = 0.4, 95% confidence interval (CI) 0.18, 0.61), the incidence of respiratory complications (ARR = 0.36, 95% CI (0.08, 0.58)), and requirement for a tracheostomy (ARR = 0.18, 95% CI (-0.05, 0.4)) were significantly reduced by using a respiratory protocol. A clinical pathway reduced duration of mechanical ventilation by 6 days 95% CI (-0.56, 12.56), intensive care unit length of stay by 6.8 days 95% CI (0.17-13.77) and costs. Intubation, mechanical ventilation, and tracheostomy are the mainstay of respiratory management for complete injuries above the level of C5.
  
  
  CONCLUSIONS
  This review showed a clinical pathway with a structured respiratory protocol that includes a combination of treatment techniques provided regularly is effective in reducing respiratory complications and cost. The overall study quality was moderate and further studies using specific interventions that target respiratory complications are associated with specific regions of the cervical spine using more methodologically rigorous designs are required.
authors.affiliation: Physiotherapy Department, Austin Hospital, Melbourne, Victoria, Australia. sue.berney@austin.org.au
authors.forename: S
authors.initials: S
authors.lastname: Berney
authors.forename: P
authors.initials: P
authors.lastname: Bragge
authors.forename: C
authors.initials: C
authors.lastname: Granger
authors.forename: H
authors.initials: H
authors.lastname: Opdam
authors.forename: L
authors.initials: L
authors.lastname: Denehy
mesh_terms: D002574:Cervical Vertebrae / Q000293:injuries*; D002985:Clinical Protocols / Q000592:standards*; D006801:Humans; D011782:Quadriplegia / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D012133:Respiratory Paralysis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D013119:Spinal Cord Injuries / Q000150:complications / Q000175:diagnosis / Q000628:therapy*