Paul Amrutha Liz, Varaham Ram, Balaraman Kannan, Rajasekaran S, Balasubramani V M
Department of Critical Care, Ganga Medical Centre & Hospitals, Coimbatore, Tamil Nadu, India.
Department of Oral and Maxillofacial Surgery, Ganga Medical Centre & Hospitals, Coimbatore, Tamil Nadu, India.
Indian J Crit Care Med. 2022 Oct;26(10):1086-1090. doi: 10.5005/jp-journals-10071-24322.
Anterior cervical spine fixation (ACSF) is a common mode of stabilization of cervical spine injuries. These patients usually need a prolonged mechanical ventilation, so an early tracheostomy is beneficial for them. However, it is often delayed due to the close proximity to the surgical site, due to the concerns of infection, and increased bleeding. Percutaneous dilatational tracheostomy (PDT) is also considered a relative contraindication due to the inability to achieve adequate neck extension.
The objectives of our study are to assess the:Feasibility of performing a very early percutaneous dilatational tracheostomy in cervical spine injury patients, post-anterior cervical spine fixation.Safety in doing so with regard to surgical-site infection, early, and late complications.Benefits with regard to outcome measures like ventilator days and length of stay (LOS) in the intensive care unit (ICU) and hospital.
We performed a retrospective review of all patients who underwent anterior cervical spine fixation and bedside percutaneous dilatational tracheostomy in our ICU from 1st January 2015 to 31st March 2021.
Out of the 269 patients admitted to our ICU with cervical spine pathology, 84 were included in the study. About 40.4% patients had injury above C5 level (-34) and 59.5% had below C5 level. About 86.9% patients had ASIA-A neurology. In our study, percutaneous tracheostomy was done at an average of 2.8 days from the cervical spine fixation. Average length of ventilator days post-tracheostomy was 8.32 days, ICU stay was 10.5 days, and hospital stay was 28.6 days. One patient developed anterior surgical-site infection.
We conclude from our study that a very early percutaneous dilatational tracheostomy can be done in post-anterior cervical spine fixation patients as early as within 3 days without significant complications.
Paul AL, Varaham R, Balaraman K, Rajasekaran S, Balasubramani VM. Safety and Feasibility of Very Early Bronchoscopy-assisted Percutaneous Dilatational Tracheostomy in Anterior Cervical Spine Fixation Patients. Indian J Crit Care Med 2022;26(10):1086-1090.
颈椎前路固定术（ACSF）是颈椎损伤稳定治疗的常见方式。这些患者通常需要长时间机械通气，因此早期气管切开术对他们有益。然而，由于手术部位临近、担心感染以及出血增加，气管切开术常常被延迟。经皮扩张气管切开术（PDT）也因无法实现充分的颈部伸展而被视为相对禁忌证。
我们研究的目的是评估：颈椎损伤患者在颈椎前路固定术后极早期进行经皮扩张气管切开术的可行性。这样做在手术部位感染、早期和晚期并发症方面的安全性。在诸如呼吸机使用天数、重症监护病房（ICU）和医院住院时间等结局指标方面的益处。
我们对2015年1月1日至2021年3月31日期间在我们ICU接受颈椎前路固定术和床边经皮扩张气管切开术的所有患者进行了回顾性研究。
在我们ICU收治的269例颈椎病变患者中，84例纳入研究。约40.4%的患者损伤位于C5水平以上（-34例），59.5%位于C5水平以下。约86.9%的患者美国脊髓损伤协会（ASIA）神经功能分级为A。在我们的研究中，经皮气管切开术平均在颈椎固定术后2.8天进行。气管切开术后呼吸机平均使用天数为8.32天，ICU住院时间为10.5天，医院住院时间为28.6天。1例患者发生手术部位前方感染。
我们从研究中得出结论，颈椎前路固定术后的患者可在3天内尽早进行极早期经皮扩张气管切开术，且无明显并发症。
Paul AL, Varaham R, Balaraman K, Rajasekaran S, Balasubramani VM. 颈椎前路固定患者极早期支气管镜辅助经皮扩张气管切开术的安全性和可行性[J]. 印度重症医学杂志, 2022, 26(10): 1086-1090.
