Summary

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.

There is level 2 evidence (from one RCT: Sustic et al. 2002) that percutaneous dilational tracheostomies are a significantly shorter procedure and have fewer pulmonary complications compared to surgical tracheostomies for individuals with acute SCI.

There is level 2 evidence (from one cohort study: Leelapattana et al. 2012) that tracheostomies can reduce the number of pulmonary complications in individuals with acute SCI compared to late or no tracheostomy.

There is level 2 evidence (from one cohort study: Romero-Ganuza et al. 2011a) that tracheostomies performed directly after spinal fixation surgery do not increase the rate of surgical wound infection compared to non-immediate tracheostomies in acute SCI individuals.

There is level 3 evidence (from one case control study: McCully et al. 2014; and one case series: Kornblith et al. 2014) that acute SCI individuals who receive a tracheostomy may spend more days on a ventilator than those who do not.

There is level 3 evidence (from one case control study: Berney et al. 2011) that acute SCI individuals who receive a tracheostomy, compared to those who are extubated, may have more pulmonary secretions, lower gas exchange, and lower forced vital capacity.

There is level 4 evidence (from one case series: O’Keeffe et al. 2004) that tracheostomies in acute SCI individuals may not increase the risk of neurologic deterioration or surgical site infection.

There is level 2 evidence (from one prospective controlled trial: Gregoretti et al. 2005) that endotracheal invasive ventilation may lower partial pressure of carbon dioxide compared to transtracheal open ventilation in acute SCI individuals.

There is level 3 evidence (from one case control study: Watt et al. 2011) that diaphragm pacing in combination with mechanical ventilation may result in higher survival than mechanical ventilation alone in acute SCI populations.

There is level 3 evidence (from one case control study: Romero-Ganuza et al. 2011b) that percutaneous tracheostomies may result in fewer cases of pneumonia compared to surgical tracheostomies in acute SCI individuals.

There is level 3 evidence (from five case control studies: Beom and Seo 2018; Flanagan et al. 2018; Choi et al. 2013; Romero-Ganuza et al. 2011b; Romero et al. 2009) that early tracheostomies may result in fewer ICU days than late tracheostomies in acute SCI patients.

There is level 3 evidence (from four case control studies: Flanagan et al. 2018; Choi et al. 2013; Romero-Ganuza et al. 2011b; Romero et al. 2009) that early tracheostomies may result in fewer ventilation days compared to late tracheostomies in acute SCI patients.

There is conflicting level 3 evidence (from six case control studies: Flanagan et al. 2018; Choi et al. 2013; Babu et al. 2013; Romero-Ganuza et al. 2011b; Romero et al. 2009; Kornblith et al. 2014) as to whether or not early tracheostomies decrease the risk of medical complications compared to late tracheostomies in acute SCI patients.

There is level 3 evidence (from 3 case control studies: Flanagan et al. 2018; Romero-Ganuza et al. 2011b; Romero et al. 2009) that the timing of tracheostomy may not influence in-hospital mortality rates in acute SCI individuals.

There is level 3 evidence (from one case control study: Kornblith et al. 2014) that acute SCI patients who do not require tracheostomies have a higher success rate of mechanical ventilation weaning compared to those who do require this procedure.

There is level 3 evidence (from two case control studies: Nakashima et al. 2013; Call et al. 2011) that higher level SCI correlates with lower rates of decannulation and extubation in acute SCI patients.

There is level 2 evidence (from one cohort study: Peterson et al. 1999) that higher ventilator tidal volumes may speed up the mechanical ventilation weaning process compared to lower ventilator tidal volumes in acute SCI patients.

There is level 3 evidence (from one case control: Peterson et al. 1994) that progressive ventilator-free breathing is a more successful method of weaning acute cervical SCI patients from mechanical ventilation than intermittent mandatory ventilation.

There is level 2 evidence (from one RCT: Pillastrini et al. 2006) in support of mechanical insufflation/exsufflation as an effective adjunctive therapy to the use of respiratory kinesitherapy for bronchial clearance in acute SCI patients.

There is level 1b evidence (from two RCTs: Postma et al. 2014; Derrickson et al. 1992; and one case control study: Raab et al. 2018) in support of inspiratory muscle training as an effective means to improve respiratory muscle function compared to usual care in acute SCI patients regardless of AIS status.

There is level 3 evidence (from one case control: Berney et al. 2002) that extubation and intensive physiotherapy reduces length of stay in intensive care in acute SCI patients.

There is level 3 evidence (from one case control study: Kerwin et al. 2018) that diaphragm pacing may not increase the risk of ventilator associated pneumonia or reduce the number of ventilator days compared to no implantation for acute SCI patients.

There is level 4 evidence (from one pre-post study: Stiller et al. 1992) that intermittent positive pressure breathing may increase lung volume as well as vital lung capacity in acute SCI individuals.

There is level 1b evidence (from one RCT: Barratt et al. 2012) that bronchodilator therapy with salbutamol may improve pulmonary function compared to placebo in acute SCI patients.

There is level 1b evidence (from one RCT: Li et al. 2012) that high-dose ambroxol may reduce postoperative respiratory complications and increase blood oxygenation following surgery compared to placebo in acute cervical SCI patients.

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.