title: Identification of risk factors for respiratory complications in upper cervical spinal injured patients with neurological impairment.
abstract: OBJECTIVE
  Clinical features of respiratory complications in patients with upper cervical spine injuries (CSI) are unique due to the complex regional anatomy in the region. The objective of this study was to identify the risk factors for respiratory complications in the patients with upper CSI and cervical spinal cord injuries (C-SCI).
  
  
  METHODS
  Ninety-two patients (out of 1593 spine injured patients) who met the inclusion criteria of upper CSI were admitted to our hospital from 1992 to 2010. Their records were retrospectively reviewed.
  
  
  RESULTS
  Respiratory complications occurred in 16 patients (17.4%). In addition, ventilator-associated pneumonia played an important role in the respiratory complications, however, no pulmonary thromboembolism was found. Death rate in respiratory complication group (RCG, 31.3%) was significantly higher than that in non-respiratory complication group (NCG, 1.3%). In RCG, severe C-SCI (American Spinal Cord Injury Association Grades A and B, OR=34.401; 95% CI, 2.609-5.525) and hypoalbuminemia (OR=24.616; 95% CI, 1.492-6.182) were identified by logistic regression analysis as main risk factors for respiratory complications; whereas levels of neurological injury, quadriplegia, atlanto-axial fractures, smoking history, and electrolyte disturbances were not identified as risk factors (although statistically relevant to respiratory complications).
  
  
  CONCLUSIONS
  Severe C-SCI and hypoalbuminemia played important roles in predicting respiratory complications among the patients with upper CSI and neurological impairment. In addition, levels of neurological injury, quadriplegia, atlanto-axial fractures, smoking history, and electrolyte disturbances are also valuable indicators for these complications. Moreover, prevention of ventilator-associated pneumonia was crucial in the treatment of these patients. However, a screening for deep venous thrombosis was seemingly unnecessary in our patients.
authors.affiliation: Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Chen
authors.forename: Jiang
authors.initials: J
authors.lastname: Shao
authors.forename: Wei
authors.initials: W
authors.lastname: Zhu
authors.forename: Lian Shun
authors.initials: LS
authors.lastname: Jia
authors.forename: Xiong Sheng
authors.initials: XS
authors.lastname: Chen
mesh_terms: D000328:Adult; D001268:Atlanto-Axial Joint / Q000293:injuries; D002574:Cervical Vertebrae / Q000293:injuries*; D006801:Humans; D034141:Hypoalbuminemia / Q000453:epidemiology; D007902:Length of Stay; D016015:Logistic Models; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control; D011379:Prognosis; D011782:Quadriplegia / Q000453:epidemiology; D012131:Respiratory Insufficiency / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013124:Spinal Injuries / Q000150:complications*