Effect of technique and timing of tracheostomy in patients with acute traumatic spinal cord injury undergoing mechanical ventilation

The Journal of Spinal Cord Medicine, 2011 · DOI: 10.1179/107902610X12886261091875 · Published: January 1, 2011

Spinal Cord Injury Critical Care Surgery

Simple Explanation

Patients with spinal cord injuries, especially in the cervical or high thoracic regions, often have difficulty breathing and may require mechanical ventilation. Tracheostomy, a surgical procedure to create an opening in the trachea, is frequently performed in these patients to improve breathing and prevent complications associated with prolonged intubation. This study examines the impact of the timing and technique of tracheostomy on the outcomes of patients with traumatic spinal cord injuries who require mechanical ventilation.

Study Duration

3 years (June 2006 – May 2009)

Participants

323 patients with acute traumatic SCI, 297 required mechanical ventilation and 215 underwent tracheostomy

Evidence Level

Not specified

Key Findings

1
Early tracheostomy (<7 days after intubation) was associated with shorter duration of mechanical ventilation and ICU stay compared to late tracheostomy (≥7 days).
2
Tracheal stenosis was independently associated with late tracheostomy placement.
3
Percutaneous tracheostomy was associated with shorter ICU stay compared to surgical tracheostomy; a lower incidence of pneumonia was also observed in patients undergoing percutaneous tracheostomy.

Research Summary

This study assessed the effect of timing and technique of tracheostomy on morbidity, mortality, and resource utilization in patients with acute traumatic spinal cord injuries (SCIs) undergoing mechanical ventilation. Early tracheostomy may have favorable effects in patients with acute traumatic SCI, including shortened mechanical ventilation and ICU stay. Both percutaneous and surgical tracheostomy techniques can be performed safely in the ICU, although percutaneous tracheostomy may be associated with a shorter ICU stay and lower incidence of pneumonia.

Practical Implications

Early Tracheostomy Consideration

Consider early tracheostomy (within 7 days of intubation) for patients with traumatic SCI who require prolonged mechanical ventilation to potentially reduce the duration of ventilation and ICU stay.

Technique Selection

Percutaneous tracheostomy may be the preferred technique in critically ill patients with SCI due to its association with shorter ICU stays and potentially lower pneumonia rates.

Post-Cervical Fixation Safety

Tracheostomy can be safely performed shortly after cervical spine fixation surgery without increasing the risk of cross-infection.

Study Limitations

1
Lack of homogeneous treatment strategies or skill regarding the tracheostomy technique among ICU medical staff prior to admission.
2
The decision to perform tracheostomy (timing and type of technique) was taken on a clinical basis without previous randomization, potentially introducing bias.
3
The study only analyzed durations of MV and ICU stay, without considering other costs.

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury