Timely intubation with early prediction of respiratory exacerbation in acute traumatic cervical spinal cord injury
Dublin Core
Title
Timely intubation with early prediction of respiratory exacerbation in acute traumatic cervical spinal cord injury
Subject
Cervical spinal cord injury, Timely intubation, Respiratory exacerbation, Copious airway secretion
Description
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 motorcomplete injury above C5.
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 motorcomplete injury above C5.
Creator
Takafumi Yonemitsu , Azuna Kinoshita, Keiji Nagata, Mika Morishita, Tomoyuki Yamaguchi and Seiya Kato
Publisher
BMC Emergency Medicine
Date
(2021) 21:136
Contributor
Fajar bagus W
Format
PDF
Language
English
Type
Text
Files
Collection
Citation
Takafumi Yonemitsu , Azuna Kinoshita, Keiji Nagata, Mika Morishita, Tomoyuki Yamaguchi and Seiya Kato, “Timely intubation with early prediction of respiratory exacerbation in acute traumatic cervical spinal cord injury,” Repository Horizon University Indonesia, accessed February 5, 2025, https://repository.horizon.ac.id/items/show/3925.