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Hospital Programs for Respiratory Management during Acute SCI

Respiratory management for SCI patients is thought to be most effective when the care extends beyond the individual to incorporate specialized hospital programs (Parker et al. 2010). Studies have examined the effect of respiratory management programs on enhancing patient recovery and decreasing hospital stay compared to regular hospital treatment that may differ for each individual.

Table 12. Effect of Hospital Programs for Respiratory Management during Acute SCI

Author Year; Country
Score
Research Design
Sample Size
MethodsOutcome

Xiong et al. 2015

China

Case Series

N=89

Population: 89 SCI cases with bladder stones undergoing cystolitholapaxy

64 males, 25 females

Mean (SD) age in years = 35.98 (8.17)

Injury level: 57 subjects above T6

 

Treatment: 48 with with spinal anesthesia, 26 with general anesthesia, 15 with local anesthesia

 

Outcome Measures:

Presence of AD, stone size and number, length of surgery

1.     Of the 89 patients, 31 (34.83%) developed AD during the operation

2.     Patients with AD had larger stones (4.58+/-1.26 cm vs. 3.75+/-1.15cm) and a higher number of stones (2.29+/-0.86 vs. 1.74+/-0.81)

3.     83.87% of patients with AD had lesion level at or above T6 vs. 41.38% in non AD group

4.     Operation time was longer in AD group vs. non AD group (60.65+/-17.78 min vs. 49.31+/-14.31 min)

5.     Incidence rate of AD was highest in patients with local anesthesia (18/20, 90%), followed by general anesthesia (12/27, 44.44%) and spinal anesthesia (1/40, 2.5%)

Discussion

Overall, hospital programs for respiratory management have been shown to benefit individuals more so than traditional hospital care. These programs reduce length of hospital stay and ventilator days (Cameron et al., 2009; Vitaz et al., 2001; Richard-Denis et al., 2018), help individuals gain independence by initiating speaking valves sooner (Wong et al. 2012) and reduce the incidence of pulmonary complications (Vitaz et al. 2001). Although Wong et al. (2012) did not perform statistical analyses to compare the efficacy of their program, the patients who received all three respiratory management therapies had less complications than those who did not.

A newer case control study, of moderate size, found that patients admitted early to a specialized level-1 trauma center had over all fewer procedures and complications (Richard-Denis et al., 2018). Early admission to this center significantly decreased the rates of tracheostomies, as well as the total number of days in hospital. Early admitted patients spent on average 50 fewer days on ventilation (Richard-Denis et al., 2018). Another study examining specialized care by Romero-Ganuza et al. (2015) found that a third of patients were able to be weaned at the hospital, and 63/68 individuals were discharged to the community and not long-term care. All of these patients treated with a specialized respiratory care protocol, however more research is needed to determine how this level of specialized care compares to other standards of care.

Conclusion

There is level 4 evidence (from one post test; Wong et al., 2012) that the implementation of specialized respiratory management results in stabilization and improvement of respiratory status in acute SCI patients.

There is level 2 evidence (from one cohort study; Cameron et al. 2009) that the tracheostomy review and management service reduces length of hospital stay and duration of cannulation while increasing speech valve usage compared to those who do not receive tracheostomy review and management in acute SCI patients.

There is level 2 evidence (from one cohort study; Vitaz et al. 2001) that the use of a clinical care pathway reduces length of hospital stay and results in fewer complications compared to those who received regular care in acute SCI patients.

There is level 3 evidence (from one case control study; Richard-Denis et al., 2018) that early admission to a level-1 trauma center results in lower rates of tracheostomies, as well as fewer ventilator days for acute SCI patients, compared to late admission.

There is level 4 evidence (from one pre-post test; Romero-Ganuza et al., 2015) that specialized respiratory care results in a high number of community discharges in acute SCI patients.

  • Respiratory management hospital programs overall may lead to reduced procedures, ventilator days, and hospital length of stay, and improved respiratory and patient discharge status, in the acute phase post SCI.