Traumatic Cervical Spinal Cord Injury (CSCI)
Conditions
Keywords
spinal cord injury, weaning
Brief summary
Esophageal recordings of diaphragm electrical activity (EAdi) made it possible to monitor respiratory drive and the subsequent phrenic nerve conduction and respiratory neuromuscular function continuously. Thus, we designed a spontaneous breathing challenge test to monitor the change in EAdi after a maximal inspiration. We hypothesized that the absolute change (ΔEAdi) and the percentage changes change (ΔEAdi%) in EAdi after a spontaneous breathing challenge predict successful extubation in traumatic CSCI patients during acute hospitalization.
Detailed description
A retrospective cohort study enrolled adult traumatic CSCI patients who underwent mechanical ventilation and admitted to the intensive care unit (ICU) of Zhongda hospital form June 2014 to July 2018. The following inclusion criteria were used: age 18 years or older, traumatic CSCI patients with a neurologic level of injury of C1 to C8 by the American Spinal Injury Association (ASIA) standard impairment scale grade A-D patients with mechanical ventilation due to acute respiratory failure and admite to ICU, dedicated nasogastric tube with nine electrodes that allow to continuously measure diaphragm electrical activity (EAdi catheter, Maquet, Solna, Sweden) in postion. CSCI was defined as radiologically-confirmed injury to the cervical spinal column, combined with clinical signs and symptoms consistent with CSCI at that level. The exclusion criteria were: tracheostomy at time of addmition to ICU, withhold or withdraw life sustaining treatment due to other serious organ injury, can't complete instructional actions, death occurred within 7 days after injury, or postoperative MV was a direct result of surgery and had duration of less than 24 hours postoperatively. Extubation or tracheostomy was decided by the physician in charge according to the local protocol of weaning.
Interventions
OTHERNo interventation
A retrospective cohort Observational study with no intervention
Sponsors
Southeast University, China
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. age 18 years or older 2. Traumatic CSCI patients with a neurologic level of injury of C1 to C8 by the American Spinal Injury Association (ASIA) standard impairment scale grade A to D 3. patients with mechanical ventilation due to acute respiratory failure and admit to ICU 4. with dedicated nasogastric tube with nine electrodes that allow to continuously measure diaphragm electrical activity (EAdi catheter, Maquet, Solna, Sweden) in position.
Exclusion criteria
1. tracheostomy before ICU admission 2. withhold or withdraw life sustaining treatment due to other serious organ injury 3. can't complete instructional actions, 4. death occurred within 7 days after injury 5. postoperative MV was a direct result of surgery and had duration of less than 24 hours postoperatively. 6. EAdi data not available
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| extubation Success | up to 90 days | defined as no reintubation after first extubation and no tracheostomy before any extubation attempt during ICU stay |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| ventilator free days | up to 28 days | days of nowvntilation at day 7,14,28 |
| complications | up to 90 days | complications of mechanication ventilation such as VAP and so on |
| mortality | up to 90 days | in-ICU and in hospital mortality |
| length of stay | up to 90 days | length of stay in-ICU and in hospital |
Countries
China
Outcome results
None listed