Factors associated with early mortality after cervical spinal cord injury

Abstract

Background

A relatively high early mortality rate (<30 days post-injury) for cervical spinal cord injury (SCI) has been observed.

Objective

To investigate this early mortality rate observed after cervical SCI and analyze the associated influential factors.

Methods

Medical records for 1163 patients with cervical SCI were reviewed, and the number of patients with early mortality was documented. Through logistic regression analysis, the effects of age, gender, occupation, cause of injury, severity of injury, highest involved spinal cord segment, nutritional condition during hospitalization, surgical treatment, tracheotomy, etc., on early mortality were assessed. Implementation of early treatment (i.e. surgery, tracheotomy, and nutritional support) and its effect on patient prognosis were also analyzed.

Results

Early mortality occurred in 109 of 1163 patients (9.4%). Four factors affected the early mortality rate, including level and severity of SCI, whether or not surgery was performed, the time interval between SCI and surgery, malnutrition, and tracheotomy. Patients with an American Spinal Injury Association grade of A, a high cervical SCI (C1–C3), and/or no surgical intervention were statistically more likely to have early mortality (P < 0.001).

Conclusion

Severe cervical SCI, upper-level cervical cord injury, malnutrition, and inappropriate tracheotomy are risk factors for early mortality in patients with cervical SCI. Surgery can reduce early mortality. Early tracheotomy should be performed in patients with complete upper-level cervical SCI, but patients with incomplete cervical SCI or complete low-level cervical SCI should initially be treated surgically to maintain smooth airway flow.     

High‐frequency ventilation with the Dräger Babylog 8000plus: measuring the delivered frequency

Background: Ventilator frequency is one of the determinants of tidal volume delivery during high‐frequency ventilation. Clinicians increasingly use data on ventilator displays to inform their decisions. Aim: To measure the frequencies delivered by the Dräger Babylog 8000plus ventilator when used in high‐frequency mode. Methods: Ventilator waveforms using a test lung were recorded at the full range of settings 5–20 Hz using Spectra software at 1000 Hz. The changes in frequency produced by a 1‐ Hz change in set frequency were calculated. Actual and displayed frequencies were compared. Results: For settings up to 12 Hz, median (range) difference between set and delivered frequencies was 0 (?0.4 to +0.1) Hz. Above 12 Hz, delivered frequency varied by ?0.3 (?1.9 to +0.3) Hz. For 1‐ Hz changes in frequency settings, in the range 5–12 Hz, 1‐ Hz changes produced a change in delivered frequency of 1.0 (0.6–1.4) Hz. Above 12 Hz, the corresponding changes were 0.7 (0–2.9) Hz. The ventilator displays the set frequency during operation rather than the delivered frequency. Conclusion: At 12 Hz and below, the differences between set and delivered frequencies were relatively small compared with those at 13 Hz and higher. Above 13 Hz, the difference between set and delivered frequencies was up to 2.9 Hz. Some frequency setting changes did not result in a change in delivered frequency.     

双向气道正压通气与不同流速模式同步间歇指令通气在心脏术后的比较研究

目的通过与两种不同流速模式(恒速和减速)同步间歇指令通气(SIMV)比较,评价双相气道正压通气(DuoPAP)在心脏术后应用的安全性和有效性。方法选取心内直视手术者40例,术后分别采用恒速、减速SIMV和DuoPAP模式通气,比较血流动力学、血气、呼吸力学参数及呼吸肌做功指标的变化。结果DuoPAP和减速SIMV的气道压峰值(Ppeak)、气道阻力(Raw)和吸气功(WI)较恒速型SIMV明显降低(p<0·01);前两种通气模式之间比较无统计学差异(p>0·05);三种通气模式的其他指标无统计学差异(p>0·05)。结论与传统的SIMV模式比较,DuoPAP模式对血流动力学、血气参数无明显影响,且与恒速型SIMV比较,可明显降低吸气时的Ppeak、Raw和WI,应用于心脏术后是安全、有效的。     

重型颅脑损伤并发神经源性肺水肿10例治疗体会

目的：探讨神经源性肺水肿病因、诊断及治疗方法。方法：回顾分析10例重或特重型颅脑损伤后继发神经源性肺水肿患者的救治情况。结果：本组存活6例，4例因脑疝死亡。结论：神经源性肺水肿发病急、进展快、病死率高，早期诊断、正确治疗是抢救神经源性肺水肿的关键。     

曲马多对通气功能的影响

将３０例患者随机分成曲马多组（Ｔ组）和哌替啶组（Ｐ组），比较观察对通气功能的影响。采用曲马多２ｍｇ／ｋｇ（≤１００ｍｇ／次）及哌替啶１ｍｇ／ｋｇ（≤５０ｍｇ／次），稀释后５分钟滴完，观察其后５、１０、２０。３Ｏ分钟ＮＲ、ＳｐＯ２、ＶＴ、ＶＥ及动脉血气分析各项指标。结果发现Ｐ组与Ｔ组均有ＰＣＯ２轻度上升（Ｐ＞０．０５），Ｐ组ＶＴ、ＶＥ及ＳｐＯ２短时明显下降并低Ｔ组（Ｐ＜０．０１），而Ｔ组用药前后各参数无明显变化（Ｐ＞０．０５），提示哌替啶有明显呼吸抑制作用；曲马多作为麻醉期间辅助用药无进一步降低每分通气量之虑，但应注意用量及滴注速度。     

开窗通风改善门诊空气质量

目的分析医院门诊改善空气质量工作中存在的问题及解决方式。方法统计门诊内科专家诊区上午不同时间段的人员流量;空气采样后用普通营养琼脂平板培养浮游菌落,比较干预前后专家诊区空气质量,干预前仍采用常规诊区通风方法,即开诊前开窗通风30 min,干预措施根据人员流量定时开窗、湿墩布清洁地面。结果门诊专家诊区空气质量干预后较干预前明显好转,3个就诊高峰时间段空气中每立方米的浮游菌落数分别为（61.48&#177;5.43）、（51.92&#177;3.78）（、53.14&#177;7.56）CFU/m^3,与干预前空气浮游菌落比较差异有统计学意义（P〈0.05）。结论根据人员流量定时开窗、湿墩布清洁地面有利于改善诊区空气质量。     

A retrospective study of hearing, speech and language function in children with clefts following palatoplasty and veloplasty procedures at 18-24 months of age

Many cleft palate teams currently schedule palatoplasty and veloplasty within the child’s first year of life. At Hannover Medical School, palatoplasty and veloplasty are performed at 18–24 months of age. It was questioned which speech and language outcome was achieved and whether it may be influenced by: (1) type and extent of the clefts; (2) velopharyngeal inadequacy; and (3) hearing disorders. A retrospective evaluation of data collected from 1985 to 1993 was performed summarizing receptive and expressive speech and language skills of 370 children aged 4.5 years. Cleft types were unilateral cleft lip and palate (UCLP, 30.0%), bilateral cleft lip and palate (BCLP, 28.7%), cleft hard and soft palate (CP, 21.6%), cleft soft palate (cleft velum, CV, 10.8%), cleft lip and alveolus (CLA, 5.8%) and submucous clefts (SUB, 3.2%). n=86 had constant normal hearing, and n=284 had conductive hearing loss >20 dB (500–4000 Hz). Severe developmental phonology errors were found in 30–50% of children with repaired cleft palate and in less than 8% of patients with CLA and SUB. Posterior compensatory misarticulation was below 15% in the groups UCLP, BCLP, CP, CV and SUB. Nasal resonance and air emission was nearly normal in CLA, but was increased in 27% to 38% of the other cleft types. Children with conductive hearing loss had significantly more and severely affected phonology, morphology, syntax, vocabulary, language comprehension, and auditory perception than normal hearing children. Findings indicated that speech and language function in CLP patients were predominantly related to the hearing status.     

Swallowing/ventilation interactions during oral swallow in normal children and children with cerebral palsy

Many children with cerebral palsy (CP) suffer from feeding disorders. Twenty children with spastic CP and 20 neurologically normal children (age range 6.2–12.9 years) were monitored with ultrasound imaging of the oral cavity synchronized with surface electromyographic (EMG) recordings of masseter and infrahyoid museles and respiratory inductance plethysmograph (RIP) recordings during feeding tasks. A lip-cup contact detector signaled contact of the drinking cup on the lip during liquid tasks. Children with CP required more time than normals for collection and organization of 5 ml and 75 ml liquid boluses for swallowing. The ventilatory preparation phase, recovery to baseline resting ventilatory pattern after swallowing, and total time for task completion were longer in children with CP for 5-ml and 75-ml tasks. The interval from lip-cup contact until alteration of ventilation from baseline resting ventilatory pattern was longer for children with CP during 75-ml tasks but not for 5-ml tasks. The interval from completion of the task-related cookie swallow until initiation of the next swallow was longer in children with CP than in normal children. These data provide evidence than children with CP manage solid boluses more easily than liquid boluses and small liquid boluses more easily than large liquid boluses. This investigation statistically confirms empirically based recommendations that children with CP be allowed more time to complete feeding tasks and consume small volume drinks rather than large volume drinks.