Fukuyama Yuita, Okada Kazuhiro, Tagami Takashi, Hara Yoshiaki, Yokobori Shoji
Department of Shock and Trauma Center, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba 2701694, Japan.
Department of Emergency and Critical Care Medicine, Nippon Medical School, Bunkyo-ku, Tokyo 1138603, Japan.
Trauma Surg Acute Care Open. 2025 Jan 4;10(1):e001631. doi: 10.1136/tsaco-2024-001631. eCollection 2025.
Patients with cervical spinal cord injuries (CSCIs) have a high incidence of respiratory complications. The effectiveness of non-invasive positive pressure ventilation (NPPV) in preventing respiratory complications such as pneumonia in acute CSCIs remains unclear. We evaluated whether intermittent NPPV (iNPPV) could prevent pneumonia in patients with acute CSCIs.
This single-center, retrospective study evaluated patients diagnosed with CSCIs with American Spinal Injury Association Impairment Scale scores of A-C between January 2012 and December 2022. Patients were categorized based on receipt of iNPPV into the iNPPV and usual care groups. Prophylactic iNPPV was defined as the initiation of iNPPV within 72 hours of admission. The primary outcome was the development of pneumonia. The secondary outcomes were other respiratory complications (tracheal intubation and tracheostomy) and adverse events (delirium and vomiting). The groups were compared with regard to outcomes after adjustment for patient backgrounds using inverse probability of treatment weighting (IPTW) with propensity scores.
Of the 213 patients during the study period, 94 were included. Of these, 61 (64.9%) received prophylactic iNPPV. The incidence of pneumonia was 27.9% in the iNPPV group and 48.5% in the usual care group in the unadjusted cohort. In the propensity score analysis using IPTW, the iNPPV group showed a lower incidence of pneumonia than the usual care group (29.0% vs 56.5%, p<0.001). Tracheal intubation and tracheostomy were less common in the iNPPV group than those in the usual care group (10.6% vs 29%; p=0.001 and 10.6% vs 27.1%; p=0.003, respectively). The incidences of delirium and vomiting did not increase in the iNPPV group.
Prophylactic iNPPV was associated with a lower incidence of pneumonia in patients with acute CSCIs.
Ⅳ.
颈脊髓损伤（CSCI）患者发生呼吸并发症的几率很高。无创正压通气（NPPV）在预防急性颈脊髓损伤患者肺炎等呼吸并发症方面的有效性尚不清楚。我们评估了间歇性NPPV（iNPPV）能否预防急性颈脊髓损伤患者的肺炎。
这项单中心回顾性研究评估了2012年1月至2022年12月期间被诊断为颈脊髓损伤且美国脊髓损伤协会损伤量表评分为A - C级的患者。根据是否接受iNPPV将患者分为iNPPV组和常规护理组。预防性iNPPV定义为入院72小时内开始使用iNPPV。主要结局是肺炎的发生。次要结局是其他呼吸并发症（气管插管和气管切开术）和不良事件（谵妄和呕吐）。使用倾向评分的治疗权重逆概率（IPTW）对患者背景进行调整后，比较两组的结局。
在研究期间的213例患者中，94例被纳入。其中，61例（64.9%）接受了预防性iNPPV。在未调整的队列中，iNPPV组肺炎发生率为27.9%，常规护理组为48.5%。在使用IPTW的倾向评分分析中，iNPPV组的肺炎发生率低于常规护理组（29.0%对56.5%，p<0.001）。iNPPV组气管插管和气管切开术的发生率低于常规护理组（分别为10.6%对29%；p = 0.001和10.6%对27.1%；p = 0.003）。iNPPV组谵妄和呕吐的发生率没有增加。
预防性iNPPV与急性颈脊髓损伤患者较低的肺炎发生率相关。
Ⅳ级。
