Table 4: Comparative or Combination Interventional Studies for Respiratory Function during Acute SCI.

Author Year
Country
Research Design
Sample Size
Methods Outcomes
Gregoretti et al. (2005)
Italy
Prospective Controlled Trial
N=10
Population: Mean age: 34 yr; Gender: male=10, female=0; Level of injury: C4-C6; Severity of injury: not specified.
Intervention: Patients first received endotracheal invasive ventilation (EIV) for 1-15 days and then later received transtracheal open ventilation (TOV) for 1 day.
Outcome Measures: The following during EIV treatment, at 1-hr post TOV treatment, and 24 hrs post TOV treatment: ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2), arterial blood gas analysis in the form of partial pressure of inspired oxygen in arterial blood (PaO2), partial pressure of carbon dioxide in arterial blood (PaCO2), Respiratory rate, pressure within the distal trachea, pressure-time product of esophageal pressure.
Chronicity: Time since injury not specified.
1. There were no significant differences between the EIV treatment and the TOV treatment with regards to PaO2/FiO2, PaO2, respiratory rate, and pressure within the distal trachea (p>0.05).

2. Patients had a significantly lower PaCO2 while receiving EIV compared to 1 hr post TOV and 24 hr post TOV (p<0.0001).

3. Patients had a significantly lower pressure-time product of esophageal pressure after 24 hr of receiving TOV compared to 1 hr post TOV and during EIV (p<0.05).

 

Watt et al. (2011)
United Kingdom
Case Control
N=189
Population: Mean age: 32 yr; Gender: male=163, female=26; Level of injury: C1-S5; Severity of injury: complete=136, incomplete=53; AIS A-D.
Intervention: Patients were either weaned from ventilation at discharge or remained on ventilation at discharge. Among those who required mechanical ventilation, some patients also used diaphragm pacing. Patients were further stratified by age 0-30 yr, 31-45 yr, and 46+ yr.
Outcome Measures: Mean survival time.
Chronicity: Time since injury not specified. The date of ventilation was within a few days of injury.
1. Patients aged 31-35 who were weaned from the ventilator at discharge had a significantly higher mean survival time than patients who still required ventilation at discharge (p=0.047). There were no significant differences in survival times in the other age groups.

2. Among those who required mechanical ventilation at discharge, patients who used diaphragm pacing had a significantly better survival than the group who only used mechanical ventilation (p<0.05).

Romero-Ganuza et al. (2011b)
Spain
Case Control
N=323
Population: Mean age: 42 yr; Gender: male=255, female=68; Level of injury: cervical to thoracic; Severity of injury: complete=229, incomplete=94.
Intervention: Patients either received a tracheostomy or did not. Of those who did, they either received a surgical tracheostomy or a percutaneous tracheostomy. They also either received an early tracheostomy (≤7 days post intubation) or a late tracheostomy (>7 days post intubation).
Outcome Measures: The following during hospital stay: incidence of tracheostomy, incidence of complications.
Chronicity: Mean interval from injury to admission=11.4 days.
1. There were 69 cases of perioperative complications following tracheostomy. Patients who received an early tracheostomy had significantly fewer cases of tracheal stenosis than patients who received a late tracheostomy (p=0.003). There were no significant differences in pneumonia (p=0.81), stomal cellulitis (p=0.45), bleeding (p=0.96), or mortality rate (p=0.22) between the two groups.

2. Patients who received a percutaneous tracheostomy experienced fewer cases of pneumonia (p=0.011) compared to patients who received a surgical tracheostomy.

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