Intensive Care Unit, Anesthesia and Critical Care Department, Hôtel Dieu-HME, University Hospital of Nantes and UPRES EA 3826: "Thérapeutiques cliniques et expérimentales des infections", Nantes, France.
Intensive Care Unit, Anesthesia and Critical Care Department, University Hospital of Rennes and INSERM U991 "Foie, métabolisme et cancer", Rennes, France.
J Crit Care. 2014 Apr;29(2):313.e7-13. doi: 10.1016/j.jcrc.2013.11.021. Epub 2013 Dec 2.
Respiratory complications constitute an important determinant of length of stay in tetraplegic patients. In a population of tetraplegic patients, we investigated the factors involved in the duration of mechanical ventilation (MV) and whether the duration of MV was associated with the long-term neurologic status.
In a retrospective study in 3 intensive care units (ICUs) (January 2001 to December 2009), consecutive patients (≥ 18 years) hospitalized for acute (≤ 24 hours) traumatic tetraplegia were included in the study. Patients with severe brain injury or who died in the first 48 hours were excluded. The primary outcome was the duration of MV. The secondary outcomes were the American Spinal Injury Association (ASIA) motor score on ICU discharge and at 1 year.
A total of 164 consecutive adult patients with tetraplegia were analyzed. Median (interquartile range) ASIA motor scores were 15 (6-26) on admission, 22 (9-40) on ICU discharge (n = 145 survivors), and 37 (10-80) at 1 year (n = 52 complete follow-up). The median duration of MV was 11 (2-26) days. In multivariate analysis, MV duration increased with pneumonia (P < .0001), atelectasis (P = .0042), and tracheotomy (P < .0001). In exploratory analysis, an increased duration of MV was the only factor associated in multivariate analysis with a low ASIA motor score on ICU discharge (P = .0201) and at 1 year (P = .0003).
Prevention of pneumonia and atelectasis is critical for the reduction of MV in tetraplegic patients. Prolonged MV was independently associated with poor neurologic status.
呼吸并发症是四肢瘫痪患者住院时间长短的一个重要决定因素。在一组四肢瘫痪患者中，我们研究了与机械通气（MV）持续时间相关的因素，以及 MV 持续时间是否与长期神经状态相关。
在 3 个重症监护病房（ICU）（2001 年 1 月至 2009 年 12 月）进行的回顾性研究中，纳入了因急性（≤24 小时）创伤性四肢瘫痪住院的连续患者（≥18 岁）。排除严重脑损伤或在最初 48 小时内死亡的患者。主要结局是 MV 持续时间。次要结局是 ICU 出院时和 1 年时的美国脊髓损伤协会（ASIA）运动评分。
共分析了 164 例连续成年四肢瘫痪患者。入院时的中位数（四分位距）ASIA 运动评分分别为 15（6-26），145 例存活患者的 ICU 出院时为 22（9-40），52 例完成随访的患者在 1 年时为 37（10-80）。MV 持续时间的中位数为 11（2-26）天。多变量分析显示，MV 持续时间随着肺炎（P<0.0001）、肺不张（P=0.0042）和气管切开术（P<0.0001）而增加。在探索性分析中，MV 持续时间延长是 ICU 出院时（P=0.0201）和 1 年时（P=0.0003）ASIA 运动评分低的唯一多变量分析相关因素。
预防肺炎和肺不张对于减少四肢瘫痪患者的 MV 至关重要。MV 持续时间延长与神经状态不良独立相关。
