Abstract

This study aimed to evaluate the effects of early versus late tracheostomies among patients with cervical spinal cord injuries (CSCIs). This retrospective study included 69 adult CSCI patients who underwent bedside percutaneous tracheostomies at the Intensive Care Unit of Khoula Hospital, Muscat, Oman, between January 2011 and October 2015. The tracheostomy was considered early if the procedure took place within one week of the CSCI. The impact of an early tracheostomy on patient outcomes was analysed in terms of duration of mechanical ventilation and intensive care unit (ICU) stay among patients with high (C1-C2 vertebrae) and low (C3-C7 vertebrae) CSCIs. Ventilator dependence, bradycardia episodes and surgical intervention outcomes were also examined. Patients with a high CSCI who underwent an early tracheostomy spent significantly fewer days on mechanical ventilation compared to those who underwent a late tracheostomy (9.3 ± 7.2 days versus 13.7 ± 3.2 days; P = 0.041). Low CSCI patients who received an early tracheostomy also experienced significantly fewer days on mechanical ventilation compared to those undergoing a late tracheostomy (12.1 ± 10.4 days versus 25.2 ± 17.7 days; P = 0.035). Moreover, ICU mortality was significantly lower for high CSCI patients who underwent an early tracheostomy (P = 0.015). However, there was no association between length of ICU stay and either type of CSCI or timing of the tracheostomy procedure. An early tracheostomy is beneficial in reducing the duration of mechanical ventilation among patients with CSCIs, irrespective of the level of injury.

Highlights

  • This study aimed to evaluate the effects of early versus late tracheostomies among patients with cervical spinal cord injuries (CSCIs)

  • There was no association between length of intensive care unit (ICU) stay and either type of CSCI or timing of the tracheostomy procedure

  • Advances in Knowledge - The current study sought to determine the ideal timing of a tracheostomy and its impact on patient outcomes, which is a subject of substantial controversy. - An early tracheostomy was found to significantly reduce the duration of mechanical ventilation in patients with both high and low cervical spinal cord injuries (CSCIs). - High CSCI patients had significantly lower mortality when undergoing an early tracheostomy compared to those receiving a late tracheostomy; this trend was not observed for patients with low CSCIs

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Summary

Introduction

Abstract: Objectives: This study aimed to evaluate the effects of early versus late tracheostomies among patients with cervical spinal cord injuries (CSCIs). The impact of an early tracheostomy on patient outcomes was analysed in terms of duration of mechanical ventilation and intensive care unit (ICU) stay among patients with high (C1–C2 vertebrae) and low (C3–C7 vertebrae) CSCIs. Ventilator dependence, bradycardia episodes and surgical intervention outcomes were examined. Results: Patients with a high CSCI who underwent an early tracheostomy spent significantly fewer days on mechanical ventilation compared to those who underwent a late tracheostomy (9.3 ± 7.2 days versus 13.7 ± 3.2 days; P = 0.041). Low CSCI patients who received an early tracheostomy experienced significantly fewer days on mechanical ventilation compared to those undergoing a late tracheostomy (12.1 ± 10.4 days versus 25.2 ± 17.7 days; P = 0.035). - An early tracheostomy was found to significantly reduce the duration of mechanical ventilation in patients with both high and low cervical spinal cord injuries (CSCIs).

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