Subscribe to RSS
DOI: 10.1055/s-0036-1592189
Critical Care of Traumatic Cervical Spinal Cord Injuries: Preventing Secondary Injury
Publication History
Publication Date:
01 December 2016 (online)
![](https://www.thieme-connect.de/media/sin/201606/lookinside/thumbnails/10-1055-s-0036-1592189_160061-1.jpg)
Abstract
The incidence of traumatic spinal cord injury (SCI) has not changed much over the years due to an aging population suffering falls, yet advances have been made in quality of life and survival time. In addition to initial medical and surgical stabilization, modern intensive care unit (ICU) care throughout the critical early period following SCI is essential to avoid continued secondary injury to the spinal cord. Cervical SCI patients are particularly prone and sensitive to periods of cardiovascular instability and respiratory failure directly resulting from their injuries. Preclinical and class III clinical data suggest improved outcomes by maintaining the mean arterial pressure > 85 mm Hg and avoiding hypoxemia at least for 7 days following cervical SCI, and this level of monitoring and support should occur in the ICU.
-
References
- 1 Chen Y, Tang Y, Allen V, DeVivo MJ. Aging and Spinal Cord Injury: External Causes of Injury and Implications for Prevention. Top Spinal Cord Inj Rehabil 2015; 21 (3) 218-226
- 2 National Spinal Cord Injury Statistical Center Available at: http://www.nscisc.uab.edu . Accessed February 4, 2016
- 3 Strauss DJ, Devivo MJ, Paculdo DR, Shavelle RM. Trends in life expectancy after spinal cord injury. Arch Phys Med Rehabil 2006; 87 (8) 1079-1085
- 4 DeVivo MJ, Krause JS, Lammertse DP. Recent trends in mortality and causes of death among persons with spinal cord injury. Arch Phys Med Rehabil 1999; 80 (11) 1411-1419
- 5 DeVivo MJ, Kartus PL, Stover SL, Rutt RD, Fine PR. Cause of death for patients with spinal cord injuries. Arch Intern Med 1989; 149 (8) 1761-1766
- 6 Simard JM, Woo SK, Aarabi B, Gerzanich V. The Sur1-Trpm4 channel in spinal cord injury. J Spine 2013; 4 (Suppl. 04) 2
- 7 Hassid VJ, Schinco MA, Tepas JJ , et al. Definitive establishment of airway control is critical for optimal outcome in lower cervical spinal cord injury. J Trauma 2008; 65 (6) 1328-1332
- 8 Aarabi B, Harrop JS, Tator CH , et al. Predictors of pulmonary complications in blunt traumatic spinal cord injury. J Neurosurg Spine 2012; ; 17 (1, Suppl) 38-45
- 9 Como JJ, Sutton ER, McCunn M , et al. Characterizing the need for mechanical ventilation following cervical spinal cord injury with neurologic deficit. J Trauma 2005; 59 (4) 912-916 , discussion 916
- 10 Velmahos GC, Toutouzas K, Chan L , et al. Intubation after cervical spinal cord injury: to be done selectively or routinely?. Am Surg 2003; 69 (10) 891-894
- 11 Como JJ, Leukhardt WH, Anderson JS, Wilczewski PA, Samia H, Claridge JA. Computed tomography alone may clear the cervical spine in obtunded blunt trauma patients: a prospective evaluation of a revised protocol. J Trauma 2011; 70 (2) 345-349 , discussion 349–351
- 12 McMichan JC, Michel L, Westbrook PR. Pulmonary dysfunction following traumatic quadriplegia. Recognition, prevention, and treatment. JAMA 1980; 243 (6) 528-531
- 13 Lu K, Lee TC, Liang CL, Chen HJ. Delayed apnea in patients with mid- to lower cervical spinal cord injury. Spine 2000; 25 (11) 1332-1338
- 14 Le E, Aarabi B, Hersh DS , et al. Predictors of intramedullary lesion expansion rate on MR images of patients with subaxial spinal cord injury. J Neurosurg Spine 2015; 22 (6) 611-621
- 15 Tator CH, Fehlings MG. Review of the secondary injury theory of acute spinal cord trauma with emphasis on vascular mechanisms. J Neurosurg 1991; 75 (1) 15-26
- 16 Cotton BA, Pryor JP, Chinwalla I, Wiebe DJ, Reilly PM, Schwab CW. Respiratory complications and mortality risk associated with thoracic spine injury. J Trauma 2005; 59 (6) 1400-1407 , discussion 1407–1409
- 17 Craven DE. Epidemiology of ventilator-associated pneumonia. Chest 2000; 117 (4) (Suppl. 02) 186S-187S
- 18 Fagon JY, Chastre J, Hance AJ, Montravers P, Novara A, Gibert C. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med 1993; 94 (3) 281-288
- 19 Ball PA. Critical care of spinal cord injury. Spine 2001; 26 (24, Suppl) S27-S30
- 20 Vázquez RG, Rascado Sedes P, Mourelo Fariña M, Montoto Marqués A, Ferreiro Velasco ME. Respiratory management in the patient with spinal cord injury. BioMed Res Intl 2013; DOI: 0.1155/2013/168757.
- 21 Peterson WP, Barbalata L, Brooks CA, Gerhart KA, Mellick DC, Whiteneck GG. The effect of tidal volumes on the time to wean persons with high tetraplegia from ventilators. Spinal Cord 1999; 37 (4) 284-288
- 22 Brochard L. Non-invasive ventilation: practical issues. Intensive Care Med 1993; 19 (8) 431-432
- 23 Esteban A, Frutos F, Tobin MJ , et al; Spanish Lung Failure Collaborative Group. A comparison of four methods of weaning patients from mechanical ventilation. N Engl J Med 1995; 332 (6) 345-350
- 24 Leelapattana P, Fleming JC, Gurr KR, Bailey SI, Parry N, Bailey CS. Predicting the need for tracheostomy in patients with cervical spinal cord injury. J Trauma Acute Care Surg 2012; 73 (4) 880-884
- 25 Branco BC, Plurad D, Green DJ , et al. Incidence and clinical predictors for tracheostomy after cervical spinal cord injury: a National Trauma Databank review. J Trauma 2011; 70 (1) 111-115
- 26 Brown R, DiMarco AF, Hoit JD, Garshick E. Respiratory dysfunction and management in spinal cord injury. Respir Care 2006; 51 (8) 853-868 , discussion 869–870
- 27 Sheel AW, Reid WD, Townson AF, Ayas NT, Konnyu KJ ; Spinal Cord Rehabilitation Evidence Research Team. Effects of exercise training and inspiratory muscle training in spinal cord injury: a systematic review. J Spinal Cord Med 2008; 31 (5) 500-508
- 28 Mueller G, Hopman MT, Perret C. Comparison of respiratory muscle training methods in individuals with motor and sensory complete tetraplegia: a randomized controlled trial. J Rehabil Med 2013; 45 (3) 248-253
- 29 DiMarco AF. Restoration of respiratory muscle function following spinal cord injury. Review of electrical and magnetic stimulation techniques. Respir Physiol Neurobiol 2005; 147 (2–3) 273-287
- 30 McCaughey EJ, McLean AN, Allan DB, Gollee H. Abdominal functional electrical stimulation to enhance mechanical insufflation-exsufflation. J Spinal Cord Med 2015; 21: 1-15
- 31 Romero-Ganuza FJ, Gambarrutta-Malfatti C, Diez de la Lastra-Buigues E , et al. [Diaphragmatic pacemaker as an alternative to mechanical ventilation in patients with cervical spinal injury]. Med Intensiva 2011; 35 (1) 13-21
- 32 Garara B, Wood A, Marcus HJ, Tsang K, Wilson MH, Khan M. Intramuscular diaphragmatic stimulation for patients with traumatic high cervical injuries and ventilator dependent respiratory failure: A systematic review of safety and effectiveness. Injury 2016; 47 (3) 539-544
- 33 Avni T, Lador A, Lev S, Leibovici L, Paul M, Grossman A. Vasopressors for the treatment of septic shock: systematic review and meta-analysis. PLoS ONE 2015; 10 (8) e0129305
- 34 Yoo KY, Jeong SW, Kim SJ, Ha IH, Lee J. Cardiovascular responses to endotracheal intubation in patients with acute and chronic spinal cord injuries. Anesth Analg 2003; 97 (4) 1162-1167
- 35 Raw DA, Beattie JK, Hunter JM. Anaesthesia for spinal surgery in adults. Br J Anaesth 2003; 91 (6) 886-904
- 36 Teasell RW, Arnold JM, Krassioukov A, Delaney GA. Cardiovascular consequences of loss of supraspinal control of the sympathetic nervous system after spinal cord injury. Arch Phys Med Rehabil 2000; 81 (4) 506-516
- 37 Mathias CJ. Bradycardia and cardiac arrest during tracheal suction—mechanisms in tetraplegic patients. Eur J Intensive Care Med 1976; 2 (4) 147-156
- 38 Tator CH. Experimental and clinical studies of the pathophysiology and management of acute spinal cord injury. J Spinal Cord Med 1996; 19 (4) 206-214
- 39 Guha A, Tator CH, Rochon J. Spinal cord blood flow and systemic blood pressure after experimental spinal cord injury in rats. Stroke 1989; 20 (3) 372-377
- 40 Gerzanich V, Woo SK, Vennekens R , et al. De novo expression of Trpm4 initiates secondary hemorrhage in spinal cord injury. Nat Med 2009; 15 (2) 185-191
- 41 Levi L, Wolf A, Belzberg H. Hemodynamic parameters in patients with acute cervical cord trauma: description, intervention, and prediction of outcome. Neurosurgery 1993; 33 (6) 1007-1016 , discussion 1016–1017
- 42 Tator CH, Rowed DW, Schwartz ML , et al. Management of acute spinal cord injuries. Can J Surg 1984; 27 (3) 289-293 , 296
- 43 Vale FL, Burns J, Jackson AB, Hadley MN. Combined medical and surgical treatment after acute spinal cord injury: results of a prospective pilot study to assess the merits of aggressive medical resuscitation and blood pressure management. J Neurosurg 1997; 87 (2) 239-246
- 44 Wolf A, Levi L, Mirvis S , et al. Operative management of bilateral facet dislocation. J Neurosurg 1991; 75 (6) 883-890
- 45 Chesnut RM, Marshall LF, Klauber MR , et al. The role of secondary brain injury in determining outcome from severe head injury. J Trauma 1993; 34 (2) 216-222
- 46 Khan SN, Stansby G. Cerebrospinal fluid drainage for thoracic and thoracoabdominal aortic aneurysm surgery. Cochrane Database Syst Rev 2004; (1) CD003635
- 47 Kwon BK, Curt A, Belanger LM , et al. Intrathecal pressure monitoring and cerebrospinal fluid drainage in acute spinal cord injury: a prospective randomized trial. J Neurosurg Spine 2009; 10 (3) 181-193
- 48 Martirosyan NL, Kalani MY, Bichard WD , et al. Cerebrospinal fluid drainage and induced hypertension improve spinal cord perfusion after acute spinal cord injury in pigs. Neurosurgery 2015; 76 (4) 461-468 , discussion 468–469
- 49 Werndle MC, Saadoun S, Phang I , et al. Monitoring of spinal cord perfusion pressure in acute spinal cord injury: initial findings of the injured spinal cord pressure evaluation study. Crit Care Med 2014; 42 (3) 646-655
- 50 Geerts WH, Code KI, Jay RM, Chen E, Szalai JP. A prospective study of venous thromboembolism after major trauma. N Engl J Med 1994; 331 (24) 1601-1606
- 51 Davies GC, Salzman EW. The pathogenesis of deep vein thrombosis. In: Joist JH, Sherman LA, , eds. Venous and Arterial Thrombosis: Pathogenesis, Diagnosis, Prevention, and Therapy. New York, NY: Grune and Stratton; 1979: 1-22
- 52 Green D, Rossi EC, Yao JS, Flinn WR, Spies SM. Deep vein thrombosis in spinal cord injury: effect of prophylaxis with calf compression, aspirin, and dipyridamole. Paraplegia 1982; 20 (4) 227-234
- 53 Green D, Hartwig D, Chen D, Soltysik RC, Yarnold PR. Spinal Cord Injury Risk Assessment for Thromboembolism (SPIRATE Study). Am J Phys Med Rehabil 2003; 82 (12) 950-956
- 54 Ploumis A, Ponnappan RK, Maltenfort MG , et al. Thromboprophylaxis in patients with acute spinal injuries: an evidence-based analysis. J Bone Joint Surg Am 2009; 91 (11) 2568-2576
- 55 Van Ha TG. Complications of inferior vena caval filters. Semin Intervent Radiol 2006; 23 (2) 150-155
- 56 Krassioukov AV, Furlan JC, Fehlings MG. Autonomic dysreflexia in acute spinal cord injury: an under-recognized clinical entity. J Neurotrauma 2003; 20 (8) 707-716
- 57 Gélis A, Dupeyron A, Legros P, Benaïm C, Pelissier J, Fattal C. Pressure ulcer risk factors in persons with SCI: Part I: Acute and rehabilitation stages. Spinal Cord 2009; 47 (2) 99-107
- 58 Migliorini C, Tonge B, Taleporos G. Spinal cord injury and mental health. Aust N Z J Psychiatry 2008; 42 (4) 309-314
- 59 Kennedy P, Rogers B, Speer S, Frankel H. Spinal cord injuries and attempted suicide: a retrospective review. Spinal Cord 1999; 37 (12) 847-852
- 60 Tate DG, Forchheimer MB, Krause JS, Meade MA, Bombardier CH. Patterns of alcohol and substance use and abuse in persons with spinal cord injury: risk factors and correlates. Arch Phys Med Rehabil 2004; 85 (11) 1837-1847
- 61 Cappuccino A, Bisson LJ, Carpenter B, Marzo J, Dietrich III WD, Cappuccino H. The use of systemic hypothermia for the treatment of an acute cervical spinal cord injury in a professional football player. Spine 2010; 35 (2) E57-E62
- 62 Alkabie S, Boileau AJ. The role of therapeutic hypothermia after traumatic spinal cord injury—a systematic review. World Neurosurg 2016; 86: 432-449
- 63 Levi AD, Casella G, Green BA , et al. Clinical outcomes using modest intravascular hypothermia after acute cervical spinal cord injury. Neurosurgery 2010; 66 (4) 670-677
- 64 Dididze M, Green BA, Dietrich WD, Vanni S, Wang MY, Levi AD. Systemic hypothermia in acute cervical spinal cord injury: a case-controlled study. Spinal Cord 2013; 51 (5) 395-400
- 65 Hansebout RR, Hansebout CR. Local cooling for traumatic spinal cord injury: outcomes in 20 patients and review of the literature. J Neurosurg Spine 2014; 20 (5) 550-561
- 66 Hosier H, Peterson D, Tsymbalyuk O , et al. A direct comparison of three clinically relevant treatments in a rat model of cervical spinal cord injury. J Neurotrauma 2015; 32 (21) 1633-1644
- 67 Sheth KN, Simard JM, Elm J, Kronenberg G, Kunte H, Kimberly WT. Human data supporting glyburide in ischemic stroke. Acta Neurochir Suppl (Wien) 2016; 121: 13-18