Research Center, Hopital du Sacré-Cœur de Montréal, Montréal, QC, Canada.
Faculty of Medicine, University of Montreal, CP 6128, Succ Centre-ville, Pavillon 7077 Avenue du Parc, Montréal, Québec, Canada.
Spinal Cord. 2018 Feb;56(2):142-150. doi: 10.1038/s41393-017-0003-9. Epub 2017 Nov 15.
Retrospective cohort study.
To compare the proportion of tracheostomy placement and duration of mechanical ventilation (MV) in patients with a complete cervical spinal cord injury (SCI) that were managed early or lately in a specialized acute SCI-center. The second objective was to determine the impact of the timing of admission to the SCI-center on the MV support duration.
A single Level-1 trauma center specialized in SCI care in Quebec (Canada).
A cohort of 81 individuals with complete tetraplegia over a 6-years period was included. Group 1 (N = 57- early group-) was admitted before surgical management in one specialized acute SCI-center, whereas Group 2 (N = 24 -late group-) was surgically managed in a non-specialized center and transferred to the SCI-center for post-operative management only. The proportion of tracheostomy placement and MV duration were compared. Multivariate regression analysis was used to assess the impact of the timing of admission to the SCI-center on the MV duration during the SCI-center stay.
Patients in Group 2 had a higher proportion of tracheostomy (70.8 vs. 35.1%, p = 0.004) and a higher mean duration of MV support (68.0 ± 64.2 days vs. 21.8 ± 29.7 days, p = 0.006) despite similar age, trauma severity (ISS), neurological level of injury and proportion of pneumonia. Later transfer to the specialized acute SCI-center was the main predictive factor of longer MV duration, with a strong impact factor (s = 946.7, p < 0.001).
Early admission to a specialized acute SCI-center for surgical and peri-operative management after a complete tetraplegia is associated with lower occurrence of tracheostomy and shorter mechanical ventilation duration support.
MENTOR Program of the Canadian Institute of Health Research and US Department of Defense Spinal Cord Injury Research Program.
回顾性队列研究。
比较在专门的急性脊髓损伤（SCI）中心早期或晚期接受治疗的完全性颈髓损伤（SCI）患者行气管切开术的比例和机械通气（MV）时间。第二个目的是确定入住 SCI 中心的时间对 MV 支持时间的影响。
加拿大魁北克一家专门治疗 SCI 的 1 级创伤中心。
纳入了 6 年内的 81 名完全性四肢瘫痪患者。第 1 组（N=57-早期组-）在一家专门的急性 SCI 中心接受手术治疗前入院，而第 2 组（N=24-晚期组-）在非专门中心接受手术治疗，仅在术后转入 SCI 中心接受治疗。比较气管切开术的比例和 MV 时间。多变量回归分析用于评估入住 SCI 中心的时间对 SCI 中心住院期间 MV 时间的影响。
第 2 组患者的气管切开术比例（70.8%比 35.1%，p=0.004）和 MV 支持时间（68.0±64.2 天比 21.8±29.7 天，p=0.006）更高，尽管两组患者的年龄、创伤严重程度（ISS）、损伤的神经水平和肺炎比例相似。晚期转入专门的急性 SCI 中心是 MV 时间延长的主要预测因素，影响因素较大（s=946.7，p<0.001）。
在完全性四肢瘫痪后，早期入住专门的急性 SCI 中心进行手术和围手术期管理，与气管切开术发生率较低和机械通气时间较短有关。
加拿大健康研究院 MENTOR 计划和美国国防部脊髓损伤研究计划。
