AUTHOR=Sun Lin , Feng Haoyu , Mei Jun , Wang Zhiqiang , Deng Chen , Qin Zhixin , Lv Junqiao 

TITLE=One-stage tracheostomy during surgery reduced early pulmonary infection and mechanical ventilation length in complete CSCI patients

JOURNAL=Frontiers in Surgery

VOLUME=9

YEAR=2023

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2022.1082428

DOI=10.3389/fsurg.2022.1082428

ISSN=2296-875X

ABSTRACT=<sec><title>Objective</title><p>Complete cervical spinal cord injury (CSCI) is a devastating injury that usually requires surgical treatment. Tracheostomy is an important supportive therapy for these patients. To evaluate the effectiveness of early one-stage tracheostomy during surgery compared with necessary tracheostomy after surgery, and to identify clinical factors for one-stage tracheostomy during surgery in complete cervical spinal cord injury.</p></sec><sec><title>Design</title><p>Data from 41 patients with complete CSCI treated with surgery were retrospectively analyzed.</p></sec><sec><title>Participants and interventions</title><p>Ten patients (24.4%) underwent one-stage tracheostomy during surgery, thirteen (31.7%) underwent tracheostomy when necessary after surgery, and eighteen (43.9%) did not have a tracheostomy.</p></sec><sec><title>Main results</title><p>One-stage tracheostomy during surgery significantly reduced the development of pneumonia at 7 days after tracheostomy (<italic>p</italic> = 0.025), increased the PaO<sub>2</sub> (<italic>p</italic> &lt; 0.05), and decreased the length of mechanical ventilation (<italic>p</italic> = 0.005), length of stay (LOS) in the intensive care unit (ICU) (<italic>p</italic> = 0.002), hospital LOS (<italic>p</italic> = 0.01) and hospitalization expenses compared with necessary tracheostomy after surgery (<italic>p</italic> = 0.037). A high neurological level of injury (NLI) (NLI C5 and above), a high PaCO<sub>2</sub> in the blood gas analysis before tracheostomy, severe breathing difficulty, and excessive pulmonary secretions were the statistically significant factors for one-stage tracheostomy during surgery in the complete CSCI patients, but no independent clinical factor was found.</p></sec><sec><title>Conclusions</title><p>In conclusion, one-stage tracheostomy during surgery reduced the number of early pulmonary infections and the length of mechanical ventilation, ICU LOS, hospital LOS and hospitalization expenses, and one-stage tracheostomy should be considered when managing complete CSCI patients by surgical treatment.</p></sec>