[Strengthened respiratory management for lower tracheostomy risks in patients with complete cervical spinal cord injury].
OBJECTIVE
To access the feasibility of reducing tracheostomy rates in patients with complete cervical spinal cord injury through a systemic respiratory management mode.


METHODS
A retrospective review was performed for 239 patients on a systemic respiratory management mode after complete cervical spinal cord injury in Shanghai Changzheng Hospital from 2006 to 2012. Their demographic and clinical data, including age, gender, cause of injury, level of cervical spinal cord injuries, surgical approaches, tracheostomy rates and mortality rates, were collected and analyzed. Tracheostomy rates were compared with those of patients with complete cervical spinal cord injury. Tracheostomy rates were compared with those patients with complete cervical spinal cord injury from 1991 to 2005. The new respiratory management mode for patients with severe cervical spinal cord injury included maintaining adequate energy and water for patients, relieving bronchospasm, loosening phlegm, strengthening body-turning and backslapping, sputum aspiration with suction tube through nasal cavity or bronchofibroscope, strengthening deep breath and cough training, strict control of tracheostomy indications and short-term postoperative intubation reserving if necessary.


RESULTS
32 patients were implemented tracheostomy. The tracheostomy rate was 13.4%. 10 patients died, the mortality rate was 4.18%. However, the tracheostomy rate was 19.1% and mortality rate 21.4% from 1991 to 2005. The tracheostomy rate was significantly lower than before and survival rate improved significantly.


CONCLUSIONS
The systemic respiratory management mode can effectively reduce tracheostomy rate of patients with complete cervical spinal cord injury and improve their survival rate.
Department of Spinal Surgery, Shanghai Changzheng Hospital, Shanghai 200003, China.
Wei
W
Zhu
Department of Spinal Surgery, Shanghai Changzheng Hospital, Shanghai 200003, China.
Lisheng
L
Kan
Department of Spinal Surgery, Shanghai Changzheng Hospital, Shanghai 200003, China.
Yanqing
Y
Sun
Department of Spinal Surgery, Shanghai Changzheng Hospital, Shanghai 200003, China.
Xiongsheng
X
Chen
Department of Spinal Surgery, Shanghai Changzheng Hospital, Shanghai 200003, China.
Wen
W
Yuan
Department of Spinal Surgery, Shanghai Changzheng Hospital, Shanghai 200003, China. Email: jialianshun@163.com.
Lianshun
L
Jia
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000293:injuries; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000401:mortality* / Q000601:surgery*; D014139:Tracheostomy / Q000706:statistics & numerical data*; D055815:Young Adult