| 제목 |
A single-center retrospective analysis of incidence of tracheostomy and ventilator weaning for C-SCI |
| 소속 |
Pusan National University Hospital, Department of Rehabilitation medicine1 |
| 저자 |
Da Hwi Jung1*, Ra Yu Yun1, Mi Kyung Cho1, Myung Hun Jang1, Yong Beom Shin1, Sang Hun Kim1† |
Purpose
There are many trauma centers for team approach for patients from trauma and now it is important to minimize complications of survivors. Cervical spinal cord injury (C-SCI) is one of them who survived from tragic accident and it is important to overcome their physiologic dysfunction after C-SCI such as respiratory dysfunction. It is widely accepted that early rehabilitation including chest physiotherapy and early tracheostomy lead to reduced length of stay and improved mortality of patients with C-SCI.
In this study, we estimated results of early rehabilitation through multidisciplinary team approach for C-SCI at a regional trauma center retrospectively via incidence of tracheostomy and decannulation and rates of ventilator-free at discharge.
Methods
The study period is September 1st, 2016 to June 30th, 2019. 49 patients were included for C-SCI patients who admitted through the trauma center with neurologic level of injury (NLI) of C1 to C7 and American Spinal Injury Association Impairment Scale (AIS) A or B were enrolled. All of them received early rehabilitation including chest physiotherapy from intensive care unit (ICU) or general ward. Chest physiotherapy includes sputum toileting by mechanical insufflation-exsufflation with abdomen thrust maneuver, high-frequency of chest wall oscillation and education of breathing exercise such as incentive spirometer or air stacking with deep breathing and coughing training.
Results
Total 49 patients were enrolled. Patient demographics are seen in Table 1. Mean time from injury to initiation of pulmonary rehabilitation (PR) were 8.25 days with standard deviation 3.04. Incidence of tracheostomy according to NLI and/or impairment scale is seen in Table 2. Rates of ventilator-free outcome at discharge is seen in Table 3. Comparison with previous studies for rates of successful ventilator weaning according to NLI with AIS A or B is seen in Table 4. Successful ventilator weaning means 24 hours free of invasive ventilation including non-invasive ventilation (NIV).
Discussion
This study showed incidence of tracheostomy (Table 2) and rates of successful ventilator weaning rates at NLI level of our center compared to previous study (Table 3 & 4). Incidence of tracheostomy was higher on higher NLI and rates of decannulation was higher on lower NLI. Patients with NLI of C1 was failed to ventilator-wean in all study. One patient with NLI C2 with AIS A became AIS B after operation and he was extubated and applied NIV at discharge (Table 3).
Conclusion
Reduced tracheostomy rates or increased ventilator-free rate improve life quality of patients with C-SCI and reduce psychological problem. Thus, it is important to collect multi-center based prospective database to establish standardization of early rehabilitation and chest physiotherapy for traumatic SCI patients in Korea. |
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Patient demographics
Incidence of Tracheostomy & Rates of Ventilator-Free Outcome
Comparison with previous study of successful ventilator weaning rates
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