Timely intubation with early prediction of respiratory exacerbation in acute traumatic cervical spinal cord injury

Abstract Background Early routine intubation in motor-complete cervical spinal cord injury (CSCI) above the C5 level is a conventional protocol to prevent unexpected respiratory exacerbation (RE). However, in the context of recent advances in multidisciplinary respiratory management, the absolute in...

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Autores principales:	Takafumi Yonemitsu, Azuna Kinoshita, Keiji Nagata, Mika Morishita, Tomoyuki Yamaguchi, Seiya Kato
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Cervical spinal cord injury Timely intubation Respiratory exacerbation Copious airway secretion Special situations and conditions RC952-1245 Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/39795e0b1885474a981d4d23081edcc9
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spelling	oai:doaj.org-article:39795e0b1885474a981d4d23081edcc92021-11-14T12:16:00ZTimely intubation with early prediction of respiratory exacerbation in acute traumatic cervical spinal cord injury10.1186/s12873-021-00530-31471-227Xhttps://doaj.org/article/39795e0b1885474a981d4d23081edcc92021-11-01T00:00:00Zhttps://doi.org/10.1186/s12873-021-00530-3https://doaj.org/toc/1471-227XAbstract Background Early routine intubation in motor-complete cervical spinal cord injury (CSCI) above the C5 level is a conventional protocol to prevent unexpected respiratory exacerbation (RE). However, in the context of recent advances in multidisciplinary respiratory management, the absolute indication for intubation in patients with CSCI based on initial neurologic assessment is controversial because of the drawbacks of intubation. This study aimed to redetermine the most important predictor of RE following CSCI after admission without routine intubation among patients admitted with motor-complete injury and/or injury above the C5 level to ensure timely intubation. Methods We performed a retrospective review of patients with acute traumatic CSCI admitted to our hospital without an initial routine intubation protocol from January 2013 to December 2017. CSCI patients who developed RE (defined as unexpected emergent intubation for respiratory resuscitation) were compared with those who did not. Baseline characteristics and severity of trauma data were collected. Univariate analyses were performed to compare treatment data and clinical outcomes between the two groups. Further, multivariate logistic regression was performed with clinically important independent variables: motor-complete injury, neurologic level above C5, atelectasis, and copious airway secretion (CAS). Results Among 58 patients with CSCI, 35 (60.3%) required post-injury intubation and 1 (1.7%) died during hospitalization. Thirteen (22.4%) had RE 3.5 days (mean) post-injury; 3 (37.5%) of eight patients with motor-complete CSCI above C5 developed RE. Eleven of the 27 (40.7%) patients with motor-complete injury and five of the 22 (22.7%) patients with neurologic injury above C5 required emergency intubation at RE. Three of the eight CSCI patients with both risk factors (motor-complete injury above C5) resulted in emergent RE intubation (37.5%). CAS was an independent predictor for RE (odds ratio 7.19, 95% confidence interval 1.48–42.72, P = 0.0144) in multivariate analyses. Conclusion Timely intubation post-CSCI based on close attention to CAS during the acute 3-day phase may prevent RE and reduce unnecessary invasive airway control even without immediate routine intubation in motor-complete injury above C5.Takafumi YonemitsuAzuna KinoshitaKeiji NagataMika MorishitaTomoyuki YamaguchiSeiya KatoBMCarticleCervical spinal cord injuryTimely intubationRespiratory exacerbationCopious airway secretionSpecial situations and conditionsRC952-1245Medical emergencies. Critical care. Intensive care. First aidRC86-88.9ENBMC Emergency Medicine, Vol 21, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Cervical spinal cord injury Timely intubation Respiratory exacerbation Copious airway secretion Special situations and conditions RC952-1245 Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Cervical spinal cord injury Timely intubation Respiratory exacerbation Copious airway secretion Special situations and conditions RC952-1245 Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Takafumi Yonemitsu Azuna Kinoshita Keiji Nagata Mika Morishita Tomoyuki Yamaguchi Seiya Kato Timely intubation with early prediction of respiratory exacerbation in acute traumatic cervical spinal cord injury
description	Abstract Background Early routine intubation in motor-complete cervical spinal cord injury (CSCI) above the C5 level is a conventional protocol to prevent unexpected respiratory exacerbation (RE). However, in the context of recent advances in multidisciplinary respiratory management, the absolute indication for intubation in patients with CSCI based on initial neurologic assessment is controversial because of the drawbacks of intubation. This study aimed to redetermine the most important predictor of RE following CSCI after admission without routine intubation among patients admitted with motor-complete injury and/or injury above the C5 level to ensure timely intubation. Methods We performed a retrospective review of patients with acute traumatic CSCI admitted to our hospital without an initial routine intubation protocol from January 2013 to December 2017. CSCI patients who developed RE (defined as unexpected emergent intubation for respiratory resuscitation) were compared with those who did not. Baseline characteristics and severity of trauma data were collected. Univariate analyses were performed to compare treatment data and clinical outcomes between the two groups. Further, multivariate logistic regression was performed with clinically important independent variables: motor-complete injury, neurologic level above C5, atelectasis, and copious airway secretion (CAS). Results Among 58 patients with CSCI, 35 (60.3%) required post-injury intubation and 1 (1.7%) died during hospitalization. Thirteen (22.4%) had RE 3.5 days (mean) post-injury; 3 (37.5%) of eight patients with motor-complete CSCI above C5 developed RE. Eleven of the 27 (40.7%) patients with motor-complete injury and five of the 22 (22.7%) patients with neurologic injury above C5 required emergency intubation at RE. Three of the eight CSCI patients with both risk factors (motor-complete injury above C5) resulted in emergent RE intubation (37.5%). CAS was an independent predictor for RE (odds ratio 7.19, 95% confidence interval 1.48–42.72, P = 0.0144) in multivariate analyses. Conclusion Timely intubation post-CSCI based on close attention to CAS during the acute 3-day phase may prevent RE and reduce unnecessary invasive airway control even without immediate routine intubation in motor-complete injury above C5.
format	article
author	Takafumi Yonemitsu Azuna Kinoshita Keiji Nagata Mika Morishita Tomoyuki Yamaguchi Seiya Kato
author_facet	Takafumi Yonemitsu Azuna Kinoshita Keiji Nagata Mika Morishita Tomoyuki Yamaguchi Seiya Kato
author_sort	Takafumi Yonemitsu
title	Timely intubation with early prediction of respiratory exacerbation in acute traumatic cervical spinal cord injury
title_short	Timely intubation with early prediction of respiratory exacerbation in acute traumatic cervical spinal cord injury
title_full	Timely intubation with early prediction of respiratory exacerbation in acute traumatic cervical spinal cord injury
title_fullStr	Timely intubation with early prediction of respiratory exacerbation in acute traumatic cervical spinal cord injury
title_full_unstemmed	Timely intubation with early prediction of respiratory exacerbation in acute traumatic cervical spinal cord injury
title_sort	timely intubation with early prediction of respiratory exacerbation in acute traumatic cervical spinal cord injury
publisher	BMC
publishDate	2021
url	https://doaj.org/article/39795e0b1885474a981d4d23081edcc9
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Timely intubation with early prediction of respiratory exacerbation in acute traumatic cervical spinal cord injury

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