In patients with upper cervical spinal cord injury, there are cases where tracheostomy is performed because of suffocation due to hemorrhoids or atelectasis after cervical spine operation and early rehabilitation. We investigated the necessity and involvement of tracheostomy in hospitalized upper cervical spinal cord injury patients with physical and imaging findings and noninvasive examinations.
The subjects were 47 patients under the ASIA A-C classification who were injured from upper cervical spinal cord injury between 2010 and 2019. Among them, 15 patients had tracheostomy. Items to be examined were age, gender, level of cervical cord injury, complete or incomplete paralysis, pH, PaO2, PaCO2, GCS, ISS, respiratory rate, use of pressurizer, bone injury site, respiratory pattern The highest level of brightness change of MRI was examined.
The average time to intubation was 3 days and the time to tracheostomy was 12 days from admission. The level of responsibility for cervical spinal cord injury was an average C5.6 level, and a higher level required tracheostomy. Although there was no significant difference in mean blood pressure at the visit, there were many cases of using vasopressors. The average ISS was 19.44, with no significant difference between the two groups. Proximal level in which MRI intensity change was observed was an average of C3.77, but there was no significant difference observed between the two groups.
Cases with neurogenic shock have a high risk of tracheostomy. However, improved paralyzed conditions after visits were likely to require no tracheostomy. Futhermore, patients with cervical spinal cord injury had difficulty bringing up sputum, and it was thought that rehabilitation should be performed early, postural drainage and early bed removal.