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Successful tracheostomy decannulation after complete or sensory incomplete cervical spinal cord injury

Authors
 D H Kim  ;  S W Kang  ;  W A Choi  ;  H J Oh 
Citation
 Spinal Cord, Vol.55(6) : 601-605, 2017 
Journal Title
 Spinal Cord 
ISSN
 1362-4393 
Issue Date
2017
MeSH
Airway Extubation* ; Cervical Vertebrae ; Female ; Follow-Up Studies ; Humans ; Intubation* ; Male ; Middle Aged ; Respiratory Function Tests ; Retrospective Studies ; Spinal Cord Injuries/therapy* ; Tracheostomy* ; Treatment Outcome
Abstract
STUDY DESIGN: Retrospective study. OBJECTIVES: To report the successful tracheostomy decannulation/extubation in cervical spinal cord injury (C-SCI) patients. SETTING: Tertiary university hospital, pulmonary rehabilitation center. METHODS: Complete or sensory incomplete C-SCI patients who had received invasive acute phase respiratory management, and succeeded in decannulation/extubation became candidates of this study. Retrospective review was conducted on the transitions of the respiratory status. RESULTS: Sixty-two patients (M: 55, F: 7) were identified. Traumatic etiologies accounted for 93.5%, and mean onset age was 47.6±15.8 years. Sixty patients (96.8%) had undergone tracheostomy and the other two received endotracheal intubation during acute phase. All patients succeeded in decannulation/extubation after employing mechanically assisted coughing and noninvasive mechanical ventilation (NIV). Mean time since tracheostomy to decannulation was 7.0±14.5 months. Of the 60 tracheostomized patients, 12 succeeded in decannulation without applying long-term NIV, 31 switched to continuous NIV after decannulation. Fifteen patients totally weaned off from ventilators after NIV. Two patients who once succeeded in decannulation were re-tracheostomized. For the 31 patients with continuous NIV, mean hours of daily need for ventilatory support had reduced from 15.3±8.0 to 5.7±5.7 h at final follow-ups. CONCLUSION: Complete or sensory incomplete C-SCI patients, even with high neurological level can be successfully decannulated through NIV and aggressive use of mechanically assisted coughing. Undesirable tracheostomy can be avoided by employing the noninvasive respiratory management.
Full Text
http://www.nature.com/sc/journal/v55/n6/full/sc2016194a.html?foxtrotcallback=true
DOI
10.1038/sc.2016.194
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Rehabilitation Medicine (재활의학교실) > 1. Journal Papers
Yonsei Authors
Kang, Seong Woong(강성웅) ORCID logo https://orcid.org/0000-0002-7279-3893
Oh, Hyeon Jun(오현준)
Choi, Won Ah(최원아) ORCID logo https://orcid.org/0000-0003-0403-8869
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/154734
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