Invasive mechanical ventilation in the patient with spinal cord trauma: A review of the literature
Main Article Content
Abstract
Spinal cord trauma (STT) represents a serious medical emergency that compromises neurological and respiratory function. Initial injuries trigger a series of pathophysiological processes, including inflammation and ischemia, which can aggravate neural damage. Respiratory dysfunction is common due to respiratory muscle involvement and loss of diaphragmatic function. Mechanical ventilation (MV) is essential to stabilize the patient and facilitate rehabilitation. However, MV in TRM faces unique challenges, such as prevention of muscle atrophy and management of complications such as ventilatorassociated pneumonia. Specific strategies, such as noninvasive ventilation and patientrespirator synchronization, are crucial to improve outcomes. Multidisciplinary management with neurosurgeons, intensivists and physiotherapists is critical to address the clinical and functional complexities of TRM and MV, ensuring comprehensive care and optimal recovery.
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Bennet, J. (2009). Spinal Cord Injuries. StatPearls, 281–286. https://doi.org/10.1016/B978-008045046-9.00701-4
Ding W, Hu S, Wang P, Kang H, Peng R, Dong Y, et al. Spinal cord injury: The global incidence, prevalence, and disability from the Global Burden of Disease Study 2019. Spine (Phila Pa 1976) [Internet]. 2022;47(21):1532–40. Disponible en: http://doi.org/10.1097/brs.0000000000004417
Eli I, Lerner DP, Ghogawala Z. Acute traumatic spinal cord injury. Neurol Clin [Internet]. 2021;39(2):471–88. Disponible en: http://doi.org/10.1016/j.ncl.2021.02.004
1. Bennet J. Spinal Cord Injuries. StatPearls [Internet]. 2009;281–6. Available from: https://doi.org/10.1016/B978-008045046-9.00701-4
Ding W, Hu S, Wang P, Kang H, Peng R, Dong Y, et al. Spinal Cord Injury: The Global Incidence, Prevalence, and Disability From the Global Burden of Disease Study 2019. Spine (Phila Pa 1976) [Internet]. 2022;47(21):1532–40. Available from: https://doi.org/10.1097/BRS.0000000000004417
Eli I, Lerner DP, Ghogawala Z. Acute Traumatic Spinal Cord Injury. Neurol Clin [Internet]. 2021;39(2):471–88. https://doi.org/10.1016/j.ncl.2021.02.004
Ahuja CS, Nori S, Tetreault L, Wilson J, Kwon B, Harrop J, et al. Traumatic spinal cord injury - Repair and regeneration. Clin Neurosurg. 2017;80(3):S22–90.
Sharif S, Jazaib Ali MY. Outcome Prediction in Spinal Cord Injury: Myth or Reality. World Neurosurg [Internet]. 2020;140:574–90. Available from: https://doi.org/10.1016/j.wneu.2020.05.043
Park JH, Kim JH, Roh SW, Rhim SC, Jeon SR. Prognostic factor analysis after surgical decompression and stabilization for cervical spinal-cord injury. Br J Neurosurg [Internet]. 2017;31(2):194–8. Available from: https://doi.org/10.1080/02688697.2016.1247781
Chay W, Kirshblum S. Predicting Outcomes After Spinal Cord Injury. Phys Med Rehabil Clin N Am [Internet]. 2020;31(3):331–43. Available from: https://doi.org/10.1016/j.pmr.2020.03.003
Galeiras Vázquez R, Rascado Sedes P, Mourelo Fariña M, Montoto Marqués A, Ferreiro Velasco ME. Respiratory management in the patient with spinal cord injury. Biomed Res Int [Internet]. 2013;2013:24089664. https://doi.org/10.1155/2013/168757
Hoh DJ, Mercier LM, Hussey SP, Lane MA. Respiration following spinal cord injury: Evidence for human neuroplasticity. Respir Physiol Neurobiol [Internet]. 2013;189(2):450–64. https://doi.org/10.1016/j.resp.2013.07.002
Schilero GJ, Spungen AM, Bauman WA, Radulovic M, Lesser M. Pulmonary function and spinal cord injury. Respir Physiol Neurobiol [Internet]. 2009;166(3):129–41. https://doi.org/10.1016/j.resp.2009.04.002
Berlly M, Shem K. Respiratory management during the first five days after spinal cord injury. J Spinal Cord Med [Internet]. 2007; 30 (4): 309–18. Available from: https://doi.org/10.1080/10790268.2007.11753946
Schilero GJ, Bauman WA, Radulovic M. Traumatic Spinal Cord Injury: Pulmonary Physiologic Principles and Management. Clin Chest Med [Internet]. 2018;39(2):411–25. https://doi.org/10.1016/j.ccm.2018.02.002
Brown R, DiMarco AF, Hoit JD, Garshick E. Respiratory dysfunction and management in spinal cord injury. Respir Care [Internet]. 2006;51(8):853–68. https://doi.org/10.1007/978-981-19-0228-4_23
Kim SH, Shin YB, Yoon JA, Lee JS, Lee BJ, Park HE. Revisiting respiratory muscle strength and pulmonary function in spinal cord injury: The effect of body positions. Neuroendocrinol Lett. 2018;39(3):189–95.
Hassid VJ, Schinco MA, Tepas JJ, Griffen MM, Murphy TL, Frykberg ER, et al. Definitive establishment of airway control is critical for optimal outcome in lower cervical spinal cord injury. J Trauma [Internet]. 2008;65(6):1328–32. https://doi.org/10.1097/TA.0b013e31818d07e4
Tran K, Hukins C, Geraghty T, Eckert B, Fraser L. Sleep-disordered breathing in spinal cord-injured patients: A short-term longitudinal study. Respirology [Internet]. 2010;15(2):272–6. https://doi.org/10.1111/j.1440-1843.2009.01669.x
Hickey S. Mechanical Ventilation. Stat Pearls. 2023;10-1-10–4.
Reyes MRL, Elmo MJ, Menachem B, Granda SM. A primary care provider’s guide to managing respiratory health in subacute and chronic spinal cord injury. Top Spinal Cord Inj Rehabil [Internet]. 2020;26(2):116–22. https://doi.org/10.46292/SCI2602-116
Zhang Y. Acute spinal cord injury: Pathophysiology and pharmacological intervention (Review). Mol Med Rep [Internet]. 2021;23(6):3–4. https://doi.org/10.3892/mmr.2021.12056
Baabor A. M, Cruz T. S, Villalón F. J. Actualización en la fisiopatología y manejo de traumatismo raquimedular. Revisión bibliográfica. Rev Chil Neurocir [Internet]. 2019;42(2):144–50. https://doi.org/10.36593/rev.chil.neurocir.v42i2.115
Arriagada G. Traumatismo raquimedular (TRM). Revisión bibliográfica. Rev Médica Clínica Las Condes [Internet]. 31:5–6. https://doi.org/10.1016/j.rmclc.2020.11.001
Anjum A. Spinal Cord Injury: Pathophysiology, Multimolecular Interactions, and Underlying Recovery Mechanisms. Int J Mol Sci [Internet]. 2020;21(20):7533. https://doi.org/10.3390/ijms21207533
Hulsebosch CE. Recent advances in pathophysiology and treatment of spinal cord injury. Am J Physiol - Adv Physiol Educ [Internet]. 2002;26(1–4):238–55. https://doi.org/10.1152/advan.00039.2002
Raab AM, Mueller G, Elsig S, Gandevia SC, Zwahlen M, Hopman MTE, et al. Systematic review of incidence studies of pneumonia in persons with spinal cord injury. J Clin Med [Internet]. 2022;11(1):15–6. https://doi.org/10.3390/jcm11010211
Lima R, Monteiro A, Salgado AJ, Monteiro S, Silva NA. Pathophysiology and Therapeutic Approaches for Spinal Cord Injury. Int J Mol Sci [Internet]. 2022;23(22):3–4. https://doi.org/10.3390/ijms232213833
Badhiwala JH, Ahuja CS, Fehlings MG. Time is spine: A review of translational advances in spinal cord injury. J Neurosurg Spine [Internet]. 2019;30(1):1–18. https://doi.org/10.3171/2018.9.SPINE18682
Kirshblum SC, Burns SP, Biering-Sorensen F, Donovan W, Graves DE, Jha A, et al. International standards for neurological classification of spinal cord injury (Revised 2011). J Spinal Cord Med [Internet]. 2011;34(6):535–46. https://doi.org/10.1179/204577211X13207446293695
Roberts TT, Leonard GR, Cepela DJ. Classifications In Brief: American Spinal Injury Association (ASIA) Impairment Scale. Clin Orthop Relat Res [Internet]. 2017;475(5):1499–504. https://doi.org/10.1007/s11999-016-5133-4
Zhang S, Wadhwa R, Haydel J, Toms J, Johnson K, Guthikonda B. Spine and Spinal Cord Trauma. Diagnosis and Management. Neurol Clin [Internet]. 2013;31(1):183–206. https://doi.org/10.1016/j.ncl.2012.09.012
Taghva A, Hoh DJ, Lauryssen CL. Advances in the management of spinal cord and spinal column injuries. Handb Clin Neurol [Internet]. 2012;109:105–30. https://doi.org/10.1016/B978-0-444-52137-8.00007-3
Mourelo Fariña M, Salvador de la Barrera S, Montoto Marqués A, Ferreiro Velasco ME, Galeiras Vázquez R. Actualización en lesión medular aguda postraumática. Parte 2. Med Intensiva [Internet]. 2017;41(5):306–15. https://doi.org/10.1016/j.medin.2016.10.014
Bao FP, Zhang HG, Zhu SM. Anesthetic considerations for patients with acute cervical spinal cord injury. Neural Regen Res [Internet]. 2017;12(3):499–504. https://doi.org/10.4103/1673-5374.202916
Villegas W, Lawson T. Airway Management in Trauma Patients. Crit Care Nurs Clin North Am [Internet]. 2023;35(2):109–18. https://doi.org/10.1016/j.cnc.2023.02.003
Robba C, Poole D, McNett M, Asehnoune K, Bösel J, Bruder N, et al. Mechanical ventilation in patients with acute brain injury: recommendations of the European Society of Intensive Care Medicine consensus. Intensive Care Med [Internet]. 2020;46(12):2397–410. https://doi.org/10.1007/s00134-020-06283-0
Yue JK, Winkler EA, Rick JW, Deng H, Partow CP, Upadhyayula PS, et al. Update on critical care for acute spinal cord injury in the setting of polytrauma. Neurosurg Focus[Internet]. 2017;43(5):2–3. https://doi.org/10.3171/2017.7.FOCUS17396
Harrop JS, Sharan AD, Scheid EH, Vaccaro AR, Przybylski GJ. Tracheostomy placement in patients with complete cervical spinal cord injuries: American Spinal Injury Association Grade A. J Neurosurg [Internet]. 2004;100(1 SUPPL.):20–3. https://doi.org/10.3171/spi.2004.100.1.0020
Lippi L, Folli A, Turco A, Moalli S, Curci C, Ammendolia A, et al. The impact of rehabilitation in bone loss management of patients with spinal cord injury: A systematic review. J Back Musculoskelet Rehabil [Internet]. 2023;36(6):1219–35. https://doi.org/10.3233/BMR-230006
Call MS, Kutcher ME, Izenberg RA, Singh T, Cohen MJ. Spinal cord injury: Outcomes of ventilatory weaning and extubation. J Trauma - Inj Infect Crit Care [Internet]. 2011;71(6):1673–9. https://doi.org/10.1097/TA.0b013e31821e87c2
Schreiber AF, Garlasco J, Vieira F, Lau YH, Stavi D, Lightfoot D, et al. Separation from mechanical ventilation and survival after spinal cord injury: a systematic review and meta-analysis. Ann Intensive Care [Internet]. 2021;11(1):2–3. https://doi.org/10.1186/s13613-021-00938-x
Lippi L, D’Abrosca F, Folli A, Turco A, Curci C, Ammendolia A, et al. Rehabilitation interventions for weaning from mechanical ventilation in patients with spinal cord injury: A systematic review. J Back Musculoskelet Rehabil [Internet]. 2023;36(3):577–93. https://doi.org/10.3233/BMR-220201