title: Airway complications in traumatic lower cervical spinal cord injury: A retrospective study.
abstract: OBJECTIVE
  To investigate risk factors for pneumonia in patients with traumatic lower cervical spinal cord injury.
  
  
  METHODS
  Observational study, retrospective study.
  
  
  METHODS
  Spinal cord unit in a maximum care hospital.
  
  
  METHODS
  Thirty-seven patients with acute isolated traumatic spinal cord injury at levels C4-C8 and complete motor function injury (AIS A, B) treated from 2004 to 2010 met the criteria for inclusion in our retrospective analysis. The following parameters were considered: ventilation-specific parameters, re-intubation, creation of a tracheostomy, pneumonia, antibiotic treatment, and length of intensive care unit (ICU) stay and total hospitalization.
  
  
  RESULTS
  Among the patients, 81% had primary invasive ventilation. In 78% of cases a tracheostomy was created; 3% of these cases were discharged with invasive ventilation and 28% with a tracheostomy without ventilation. Pneumonia according to Centers for Disease Control criteria occurred in 51% of cases within 21±32 days of injury, and in 3% at a later date. The number of pre-existing conditions was significantly associated with pneumonia. Length of ICU stay was 25±34 days, and average total hospital duration was 230±144 days. Significant factors affecting the duration of ventilation were the number of pre-existing conditions and tetraplegia-specific complications.
  
  
  CONCLUSIONS
  Our results confirm that patients with traumatic lower cervical spinal cord injuries defined by lesion level and AIS constitute a homogeneous group. This group is characterized by a high rate of pneumonia during the first 4 weeks after injury. The number of pre-existing general conditions and spinal injury-specific comorbidities are the only risk factors identified for the development of pneumonia and/or duration of ventilation.
authors.forename: Thomas
authors.initials: T
authors.lastname: Liebscher
authors.forename: Andreas
authors.initials: A
authors.lastname: Niedeggen
authors.forename: Barbara
authors.initials: B
authors.lastname: Estel
authors.forename: Rainer O
authors.initials: RO
authors.lastname: Seidl
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058109:Airway Management / Q000706:statistics & numerical data*; D066193:Cervical Cord / Q000473:pathology*; D002574:Cervical Vertebrae / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology*; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications*; D014139:Tracheostomy / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Acute tetraplegia; Airway complications; Airway management; Lower cervical spinal cord injury; Pneumonia