Identification of risk factors for respiratory complications in upper cervical spinal injured patients with neurological impairment

Amaç: Üst servikal omurga yaralanması (SOY) bulunan hastalarda solunum yolu komplikasyonlarının klinik özellikleri, bölgenin karmaşık anatomisi nedeniyle kendine özgüdür. Bu çalışmanın amacı üst SOY ve servikal spinal kord yaralanması (S-SKY) bulunan hastalarda solunum komplikasyonlarına yönelik risk faktörlerini saptamaktı. Çalışma planı: Çalışmaya alınma kriteri olan üst servikal omurga yaralanması nedeniyle 1992 ile 2010 yılları arasında hospitalize edilmiş (omurga yaralanması bulunan 1593 hasta arasından) 92 hastanın kayıtları geriye dönük olarak incelendi. Bulgular: Toplam 16 hastada (%17.4) solunum komplikasyonuna rastlandı. Buna ek olarak, ventilatörle ilişkili pnömoni solunum komplikasyonlarında önemli rol oynamıştı, ancak, pulmoner tromboembolizm saptanmadı. Solunum komplikasyonu bulunana gruptaki ölüm oranı (SKG, %31.3), solunum yolu komplikasyonu bulunmayan gruptakinden daha yüksekti (SKBG, %1.3). SKG’de lojistik regresyon analiziyle şiddetli S-SKY (Amerikan Spinal Kord Yaralanmaları Derneği Derece A ve B, OR=34.401; %95 GA, 2.609-5.525) ve hipoalbümineminin (OR=24.616; %95 GA, 1.492-6.182) solunum komplikasyonlarına yönelik ana risk faktörleri olduğu; öte yandan nörolojik yaralanma, kuadripleji, atlanto-aksiyel kırıklar, sigara içme öyküsü ve elektrolit bozukluklarının seviyelerinin (solunum komplikasyonlarıyla istatistiksel açıdan ilişkili olsa da) risk faktörü oluşturmadığı saptandı. Çıkarımlar: Şiddetli S-SKY ve hipoalbuminemi, üst seviye SKY ve nörolojik bozukluk bulunan hastalarda solunum komplikasyonlarının öngörülmesinde önemli rol oynamıştır. Bunun yanı sıra, nörolojik yaralanma, kuadripleji, atlanto-aksiyel kırıklar, sigara içme öyküsü ve elektrolit bozukluklarının seviyeleri de bu komplikasyonlar açısından değerli göstergelerdir. Buna ek olarak, ventilatör ilişkili pnömoninin önlenmesi de bu hastaların tedavisi açısından çok önemlidir. Ancak hastalarda derin ven trombozu taraması yapılmasının gereksiz olduğu anlaşılmıştır.

Nörolojik bozuklukla birlikte üst seviye servikal spinal kord yaralanması bulunan hastalarda solunum komplikasyonları risk faktörlerinin saptanması

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). Conclusion: 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.

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  • 1. Sasso RC. C2 Dens fractures: treatment options. J Spinal Disord 2001;14:455-63.
  • 2. Al Eissa S, Reed JG, Kortbeek JB, Salo PT. Airway compro- mise secondary to upper cervical spine injury. J Trauma 2009;67:692-6.
  • 3. Krassioukov A. Autonomic function following cervical spinal cord injury. Respir Physiol Neurobiol 2009;169:157-64.
  • 4. Como JJ, Sutton ER, McCunn M, Dutton RP, Johnson SB, Aarabi B, et al. Characterizing the need for mechanical ven- tilation following cervical spinal cord injury with neurologic deficit. J Trauma 2005;59:912-6.
  • 5. Bhaskar KR, Brown R, O'Sullivan DD, Melia S, Duggan M, Reid L. Bronchial mucus hypersecretion in acute quadriple- gia. Macromolecular yields and glycoconjugate composition. Am Rev Respir Dis 1991;143:640-8.
  • 6. Cotton BA, Pryor JP, Chinwalla I, Wiebe DJ, Reilly PM, Schwab CW. Respiratory complications and mortality risk associated with thoracic spine injury. J Trauma 2005;59: 1400-9.
  • 7. Berlly M, Shem K. Respiratory management during the first five days after spinal cord injury. J Spinal Cord Med 2007; 30:309-18.
  • 8. McMichan JC, Michel L, Westbrook PR. Pulmonary dys- function following traumatic quadriplegia. Recognition, pre- vention, and treatment. JAMA 1980;243:528-31.
  • 9. Onders RP, Elmo MJ, Ignagni AR. Diaphragm pacing stim- ulation system for tetraplegia in individuals injured during childhood or adolescence. J Spinal Cord Med 2007;30 Suppl 1:S25-9.
  • 10. Durga P, Sahu BP, Mantha S, Ramachandran G. Development and validation of predictors of respiratory insufficiency and mortality scores: simple bedside additive scores for prediction of ventilation and in-hospital mortality in acute cervical spine injury. Anesth Analg 2010;110:134-40.
  • 11. Winslow C, Bode RK, Felton D, Chen D, Meyer PR Jr. Impact of respiratory complications on length of stay and hospital costs in acute cervical spine injury. Chest 2002;121: 1548-54.
  • 12. Jackson AB, Groomes TE. Incidence of respiratory compli- cations following spinal cord injury. Arch Phys Med Rehabil 1994;75:270-5.
  • 13. Reines HD, Harris RC. Pulmonary complications of acute spinal cord injuries. Neurosurgery 1987;21:193-6.
  • 14. Marino RJ, Barros T, Biering-Sorensen F, Burns SP, Donovan WH, Graves DE, et al.; ASIA Neurological Standards Committee 2002. International standards for neu- rological classification of spinal cord injury. J Spinal Cord Med 2003;26 Suppl 1:S50-6.
  • 15. Lee HC, Cho DY, Lee WY, Chuang HC. Pitfalls in treat- ment of acute cervical spinal cord injury using high-dose methylprednisolone: a retrospect audit of 111 patients. Surg Neurol 2007;68 Suppl 1:S37-42.
  • 16. Kim DH, Riew KD. Odontoid fractures: current evaluation and treatment principles. Semin Spine Surg 2007;19:235-43.
  • 17. Neumann CR, Brasil AV, Albers F. Risk factors for mortali- ty in traumatic cervical spinal cord injury: Brazilian data. J Trauma 2009;67:67-70.
  • 18. Chutkan NB, King AG, Harris MB. Odontoid fractures: evaluation and management. J Am Acad Orthop Surg 1997; 5:199-204.
  • 19.Southwick WO. The management of fractures of the dens (odontoid process). J Bone Joint Surg Am 1980;62:482-6.
  • 20.Sugimoto Y, Ito Y, Tomioka M, Tanaka M, Hasegawa Y, Nakago K, et al. Deep venous thrombosis in patients with acute cervical spinal cord injury in a Japanese population: assessment with Doppler ultrasonography. J Orthop Sci 2009; 14:374-6.
  • 21. Stolzmann KL, Gagnon DR, Brown R, Tun CG, Garshick E. Longitudinal change in FEV1 and FVC in chronic spinal cord injury. Am J Respir Crit Care Med 2008;177:781-6.
  • 22. Linn WS, Spungen AM, Gong H Jr, Bauman WA, Adkins RH, Waters RL. Smoking and obstructive lung dysfunction in persons with chronic spinal cord injury. J Spinal Cord Med 2003;26:28-35.
  • 23. Doperalski NJ, Sandhu MS, Bavis RW, Reier PJ, Fuller DD. Ventilation and phrenic output following high cervical spinal hemisection in male vs. female rats. Respir Physiol Neurobiol 2008;162:160-7.
  • 24. Lipetz JS, Kirshblum SC, O'Connor KC, Voorman SJ, Johnston MV. Anemia and serum protein deficiencies in patients with traumatic spinal cord injury. J Spinal Cord Med 1997;20:335-40.
  • 25. Frisbie JH. Anemia and hypoalbuminemia of chronic spinal cord injury: prevalence and prognostic significance. Spinal Cord 2010;48:566-9.
  • 26. Cook N. Respiratory care in spinal cord injury with associat- ed traumatic brain injury: bridging the gap in critical care nursing interventions. Intensive Crit Care Nurs 2003;19: 143-53.
  • 27. Scivoletto G, Fuoco U, Morganti B, Cosentino E, Molinari M. Pressure sores and blood and serum dysmetabolism in spinal cord injury patients. Spinal Cord 2004;42(8):473-6.
  • 28. Harrop JS, Sharan AD, Przybylski GJ. Epidemiology of spinal cord injury after acute odontoid fractures. Neurosurg Focus 2000;8:e4.
Acta Orthopaedica et Traumatologica Turcica-Cover
  • ISSN: 1017-995X
  • Başlangıç: 2015
  • Yayıncı: Türk Ortopedi ve Travmatoloji Derneği
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