Patients with acute SCI requiring ventilation are usually intubated, either in the field or upon admission to the hospital. Intubation can either be orotracheal or nasotracheal; both options are normally used for short periods of ventilation of less than 10 days (Shirawi & Arabi 2006). Prolonged intubation is not recommended as it can lead to the development of pneumonia, subglottic or tracheal stenosis, and increased airway resistance. In addition, it limits patients’ mobility, prolongs ventilator weaning, and makes pulmonary and oral hygiene difficult (Shirawi & Arabi 2006). In cases where ventilation is required for longer than 10 days, a tracheostomy is usually performed. Intubation is safest when it is performed electively under anesthesia to reduce neurological damage experienced from neck manipulation (Durbin et al. 2014), so it often occurs before a patient is experiencing severe breathing difficulty. The risk of damage is elevated when intubation is performed urgently in the case of sudden respiratory distress.
|Iwashita et al. (2006)
|Population: Mean age: 51 yr; Gender: male=40, female=8; Level of injury: C2-C7; Severity of injury: complete=28, incomplete=21.
Intervention: Patients were either intubated or not intubated.
Outcome Measures: The following retrospectively: ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2), partial pressure of carbon dioxide in arterial blood (PaCO2), arterial pH, injury severity, level of injury.
Chronicity: Time since injury not specified.
|1. Patients who were intubated experienced a significantly lower PaO2/FiO2 (p=0.0014), a lower arterial pH (p=0.0001), and a higher PaCO2 (p<0.0001), than patients who were not intubated.
2. Patients with complete injuries were intubated significantly more than patients with incomplete injuries (p=0.011).
3. Patients with a higher level of cervical SCI were intubated significantly more than patients with a lower level of cervical SCI (p=0.002).
A cohort study found that intubation significantly reduced the ratio of arterial oxygen partial pressure to fractional inspired oxygen (Iwashita et al. 2006), as well the need for intubation was higher in patients with complete injuries. This is significant as acute lung injury is present when the ratio of arterial oxygen partial pressure to fractional inspired oxygen is <300, and acute respiratory distress syndrome is present when it is <200. Several observational studies have found similar results in terms of individuals with complete injuries requiring higher rates of intubation (Como et al. 2005; Velmahos et al. 2003; Seidl et al. 2010).
There is level 2 evidence (from one cohort study: Iwashita et al. 2006) that acute SCI patients who are intubated may have reduced ratios of arterial oxygen partial pressure to fractional inspired oxygen compared to no intubation.