Respiratory management for patients undergoing tracheotomy after cervical spinal cord injury

English Keywords:Cervical spinal cord injury  Tracheotomy  Respiratory  Nursing care

English Abstract:

  【Abstract】 Objectives: Retrospectively reviewing the rehabilitation of patients suffering from cervical spinal cord injury(SCI) and undergoing tracheotomy, and to summarize the nursing keypoints for managing respiratory function and the indication for tracheotomy and extubation. Methods: Clinical materials of 92 patients with cervical SCI and undergoing tracheotomy who hospitalized from January 2008 to March 2014 were reviewed retrospectively. Including 74 males and 18 females, with an average age of 41.7±19.2(range, 28-72) years old. The follow-up period was 24±8(7-34) months. The necessary nursing care and rehabilitation training skills for respiratory included: encouraging and training for productive cough, keeping the airway wet and unobstructed, starting respiratory training step by step with vibration sputum discarding. The indications of extubation included: normal blood gas, effective voluntary cough, normal pharyngeal reflex, no lung infection, no laryngeal edema and no airway obstruction. Finally, the time span of extubation in each patient was analyzed, and the influencing factors were investigated. Results: 64 of the 92 cases(69.5%) succeeded in extubation at 44.1±14.2 (range, 11-89) days after the onset of injury, while 18 cases(19.6%) experienced delayed extubation at 138.9±5.5(125-147) days due to reccurant lung infection. 10 cases(10.9%) failed in extubation, 7 of them were caused by airway obstruction due to the hypertrophy of granulation tissue and maintained the tracheal tube at the end of the follow-up. The other 3 patients suffered from tracheal collapse after extubation, 2 of the 3 received tracheotomy again and discharged with the tracheal cannula, the rest died of acute respiratory failure． Conclusions: Well planned nursing care and proper respiratory training can help most of patients with cervical SCI and suffering from tracheotomy to remove their tracheal cannula safely in 3 and 4 months． Motor level at C4 or higher, recurrent lung infection, tracheal stenosis or collapse were the main causes of delayed or failed decannulation. The tracheal obstruction and tracheomalacia are rare but threatening life, which should be paid attention．