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01-07-2013 | Original Article

Characterizing the need for tracheostomy placement and decannulation after cervical spinal cord injury

Authors: Hiroaki Nakashima, Yasutsugu Yukawa, Shiro Imagama, Keigo Ito, Testuro Hida, Masaaki Machino, Shunsuke Kanbara, Daigo Morita, Nobuyuki Hamajima, Naoki Ishiguro, Fumihiko Kato

Published in: European Spine Journal | Issue 7/2013

Abstract

Purpose

There have been few reports on the risk factors for tracheostomy and the possibility of patients for decannulation. The purpose of this study was to identify factors necessitating tracheostomy after cervical spinal cord injury (SCI) and detect features predictive of successful decannulation in tracheostomy patients.

Methods

One hundred and sixty four patients with cervical fracture/dislocation were retrospectively reviewed. The patients comprised 142 men and 22 women with a mean age of 44.9 years. The clinical records were reviewed for patients’ demographic data, smoking history, level of cervical spine injury, injury patterns, neurological status, evidence of direct thoracic trauma and head injury, tracheostomy placement, and decannulation. Risk factors necessitating tracheostomy and factors predicting decannulation were statistically analysed.

Results

Twenty-five patients (15.2 %) required tracheostomy. Twenty-one patients were successfully decannulated. Smoking history (relative risk [RR], 3.05; p = 0.03) and complete SCI irrespective of injury level (C1–4 complete SCI: RR, 67.55; p < 0.001, C5–7 complete SCI: RR, 57.88; p < 0.001) were significant risk factors necessitating tracheostomy. C1–4 complete SCI was more frequent among those who could not be decannulated. However, even in patients with high cervical complete SCI at the time of injury, patients regaining sufficient movement to shrug their shoulders within 3 weeks after injury could later be decannulated.

Conclusions

The risk factors for tracheostomy after complete SCI were a history of smoking and complete paralysis irrespective of the level of injury. High cervical level complete SCI was found to be a risk factor for the failure of decannulation in patients without shoulder shrug within 3 weeks after injury.

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Title: Characterizing the need for tracheostomy placement and decannulation after cervical spinal cord injury
Authors: Hiroaki Nakashima
Yasutsugu Yukawa
Shiro Imagama
Keigo Ito
Testuro Hida
Masaaki Machino
Shunsuke Kanbara
Daigo Morita
Nobuyuki Hamajima
Naoki Ishiguro
Fumihiko Kato
Publication date: 01-07-2013
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 7/2013
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-013-2762-0

At a glance: The STEP trials

Springer Medicine

Characterizing the need for tracheostomy placement and decannulation after cervical spinal cord injury

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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