Early Versus Late Tracheostomy for Patients with High and Low Cervical Spinal Cord Injuries
Journal Title: Sultan Qaboos University Medical Journal - Year 2016, Vol 16, Issue 4
Abstract
Objectives: Tis study aimed to evaluate the effects of early versus late tracheostomies among patients with cervical spinal cord injuries (CSCIs). Methods: Tis retrospective study included 69 adult CSCI patients who underwent bedside percutaneous tracheostomies at the Intensive Care Unit of Khoula Hospital, Muscat, Oman, between January 2011 and October 2015. Te tracheostomy was considered early if the procedure took place within one week of the CSCI. Te impact of an early tracheostomy on patient outcomes was analysed in terms of duration of mechanical ventilation and intensive care unit (ICU) stay among patients with high (C1–C2 vertebrae) and low (C3–C7 vertebrae) CSCIs. Ventilator dependence, bradycardia episodes and surgical intervention outcomes were also examined. Results: Patients with a high CSCI who underwent an early tracheostomy spent signifcantly fewer days on mechanical ventilation compared to those who underwent a late tracheostomy (9.3 ± 7.2 days versus 13.7 ± 3.2 days; P = 0.041). Low CSCI patients who received an early tracheostomy also experienced signifcantly fewer days on mechanical ventilation compared to those undergoing a late tracheostomy (12.1 ± 10.4 days versus 25.2 ± 17.7 days; P = 0.035). Moreover, ICU mortality was signifcantly lower for high CSCI patients who underwent an early tracheostomy (P = 0.015). However, there was no association between length of ICU stay and either type of CSCI or timing of the tracheostomy procedure. Conclusion: An early tracheostomy is benefcial in reducing the duration of mechanical ventilation among patients with CSCIs, irrespective of the level of injury.
Authors and Affiliations
Akram H. Guirgis| Departments of Anaesthesia & Intensive Care Unit , Khoula Hospital, Muscat, Oman, Venugopal K. Menon| Departments of Orthopaedics, Khoula Hospital, Muscat, Oman, Neelam Suri| Departments of Anaesthesia & Intensive Care Unit , Khoula Hospital, Muscat, Oman, Nilay Chatterjee| Departments of Anaesthesia & Intensive Care Unit , Khoula Hospital, Muscat, Oman, Emil Attallah| Departments of Anaesthesia & Intensive Care Unit , Khoula Hospital, Muscat, Oman, Maged Y. Saad| Departments of Anaesthesia & Intensive Care Unit , Khoula Hospital, Muscat, Oman, Shereen Elshaer| Department of Community Medicine, Mansoura University, Mansoura, Egypt
Keywords
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