Spinal Cord Injury: Neurointensive Care and Surgical Intervention

Neurotrauma ◽  
2018 ◽  
pp. 389-400
Author(s):  
John Paul G. Kolcun ◽  
Peng-Yuan Chang ◽  
Michael Y. Wang
Keyword(s):  
Intensive Care Unit ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Intensive Care ◽  
Clinical Research ◽  
Social Status ◽  
Surgical Intervention ◽  
Hospital Staff ◽  
Neurointensive Care ◽  
Cord Injury

Spinal cord injury (SCI) is a major trauma, with profound effects on health, productivity, and social status. As new victims suffer SCI each year, hospital staff must be prepared to recognize and respond to these patients on arrival. While surgical intervention is often necessary, the major theater of SCI treatment remains the intensive care unit (ICU). This chapter describes the process of caring for SCI victims in an ICU setting, beginning with evaluation on arrival and proceeding through treatment and eventual discharge. Emphasis will be placed on well-established techniques used in approaching SCI victims, both diagnostically and therapeutically, with mention given to promising avenues of future clinical research.

scholarly journals Non-infectious Fever After Acute Spinal Cord Injury in the Intensive Care Unit

2017 ◽  
Vol 42 (3) ◽  
pp. 310-317
Author(s):  
Fatma Ülger ◽  
Mehtap Pehlivanlar Küçük ◽  
Çağatay Erman Öztürk ◽  
İskender Aksoy ◽  
Ahmet Oğuzhan Küçük ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Intensive Care ◽  
Acute Spinal Cord Injury ◽  
Cord Injury

Prophylactic Inferior Vena Cava Filter Insertion for Trauma: Intensive Care Unit versus Operating Room

2006 ◽  
Vol 72 (3) ◽  
pp. 213-216 ◽  
Author(s):  
Richard P. Gonzalez ◽  
Mabelle Cohen ◽  
Patrick Bosarge ◽  
Jeffrey Ryan ◽  
Charles Rodning
Keyword(s):  
Intensive Care Unit ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Intensive Care ◽  
Head Injury ◽  
Inferior Vena Cava ◽  
Operating Room ◽  
Inferior Vena ◽  
Vena Cava ◽  
Cord Injury

The frequency of insertion of prophylactic inferior vena cava filters (IVCF) among traumatized patients has increased nationally. That has placed a substantial operational and economic burden upon trauma centers. The purpose of this study was to compare and contrast successful implantation, morbidity, and cost-effectiveness of prophylactic IVCF insertion in a surgical-trauma intensive care unit (STICU) versus an operating room (OR). A retrospective chart review was conducted of all trauma patients who received a prophylactic IVCF at an urban Level I trauma center between January 1999 and December 2003. Data were collected to identify patient demographics, indications, anatomical site of insertion, hospital location of insertion, hospital days before insertion, and complications associated with insertion. One hundred thirty-four patients underwent prophylactic IVCF during the study period: seventy-eight (58%) in the OR and fifty-six (42%) in the STICU. The average age of patients for the OR and STICU groups were 38.6 years and 39.6 years, respectively. The average number of days to IVCF insertion was 6.5 days and 7.0 days in the OR and STICU groups, respectively. Indications for IVCF among patients who had placement in the OR were orthopedic injury (60%), spinal cord injury (25%), and head injury (15%). Indications for IVCF among patients who had placement in the STICU were head injury (38%), orthopedic injuries (34%), and spinal cord injury (25%). Three (3.8%) patients in the OR group and two (3.6%) patients in the STICU group required a change of anatomic insertion site from the femoral to the internal jugular vein. There were two (2.6%) complications associated with IVCF insertion in the OR and two (3.5%) complications associated with IVCF insertion in the STICU (P > 0.05). Insertion of IVCF in the STICU decreased patient-cost by an average of $1636 per patient. Prophylactic IVCF insertion in an STICU is cost-effective and can be performed with similar success and complication rates to IVCF insertion in an OR.

Atuação Fisioterapêutica na Lesão Medular em Unidade de Terapia Intensiva

2012 ◽  
Vol 20 (4) ◽  
pp. 612-617
Author(s):  
Lucas Lima Ferreira ◽  
Laís Helena Carvalho Marino ◽  
Imone Cavenaghi
Keyword(s):  
Intensive Care Unit ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Intensive Care ◽  
Respiratory Therapy ◽  
Cord Injury ◽  
Terapia Intensiva

Objetivo. Agrupar e atualizar conhecimentos em relação à atuação fisioterapêutica no trauma raquimedular (TRM) em unidade de terapia intensiva (UTI). Método. Foi realizada atualização de literatura nas bases de dados Lilacs, PubMed e Scielo, cruzando os descritores spinal cord injury, cinesiotherapy, physiotherapy, mobilization, rehabilitation, intensive care unit, respiratory therapy e electrotherapy, no período de 2005 a 2010. Resultados. Foram encontrados 21 estudos, porém, apenas cinco artigos preencheram os critérios de inclusão. A cinesioterapia é imprescindível desde a fase de choque medular, pois favorece a manutenção da amplitude de movimento articular e flexibilidade, além de prevenir complicações circulatórias decorrentes da imobilização prolongada no leito. A fisioterapia respiratória promove a higiene brônquica, correção de padrões ventilatórios anormais e de algumas patologias respiratórias. A eletroterapia é um recurso ainda pouco utilizado por fisioterapeutas no setor de cuidados intensivos. Conclusões. A atuação fisioterapêutica no TRM em UTI encontra-se focada na reabilitação motora por meio da cinesioterapia e na intervenção respiratória por meio da higiene brônquica e treinamento dos músculos respiratórios. Novas modalidades de tratamento, como a eletroterapia, têm surgido no ambiente intensivo, porém há necessidade de maiores estudos para confirmar benefícios e riscos deste recurso nos lesados medulares.

Neurocritical Care

2015 ◽  
Author(s):  
Terrance T. Kummer ◽  
Allan H Ropper
Keyword(s):  
Intensive Care Unit ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Critical Care ◽  
Intensive Care ◽  
Status Epilepticus ◽  
Intracerebral Hemorrhage ◽  
Myasthenia Gravis ◽  
Intracranial Hypertension ◽  
Cord Injury

Neurologic critical care encompasses the management of many nervous system diseases when they present in the extremes of severity. Core conditions managed in the neuroscience intensive care unit (ICU) include stroke, cerebral hemorrhage, status epilepticus (SE), myasthenia gravis (MG), Guillain-Barré syndrome (GBS), traumatic brain and spinal cord injury, and high-risk postoperative neurosurgical patients. The skills and knowledge base required to care for patients with such conditions, and the life-threatening complications associated with them, are drawn from both traditional neurology and from critical care medicine. This chapter covers specialized monitoring in the neurologic intensive care unit and special conditions such as acute intracranial hypertension, acute ischemic stroke, intracerebral hemorrhage, venous sinus thrombosis, myasthenia gravis, GBS, seizure and status epilepticus, spinal cord injury, and traumatic brain injury. The chapter includes 8 tables and 5 figures. Tables provide common etiologies of acute intracranial hypertension; general prophylactic measures, medical interventions, surgical interventions, and stepwise treatment protocol for acute intracranial hypertension; drugs that can exacerbate weakness in myasthenia gravis, cholinergic drug dosage equivalents and duration of action, and antiseizure medications used in status epilepticus. Figures illustrate the Monro-Kellie Doctrine, intracranial pressure waveform and plateau waves, typical herniation patterns, large stroke with malignant edema, and examples of nontraumatic intracerebral hemorrhage. This chapter contains 114 references.

Spinal Cord Injury, Intensive Care Unit (Hospital) Management

2015 ◽  
pp. 1512-1516
Author(s):  
Katarzyna H. Czerniecka ◽  
Jason H. Huang ◽  
Anthony L. Petraglia
Keyword(s):  
Intensive Care Unit ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Intensive Care ◽  
Hospital Management ◽  
Cord Injury

scholarly journals Persistent Hypertensive Response Following Dexmedetomidine Infusion in a Patient with Cervical Spinal Cord Injury

2018 ◽  
Vol 09 (03) ◽  
pp. 426-427 ◽  
Author(s):  
Siddharth Chavali ◽  
Shalendra Singh ◽  
Ashutosh Kaushal ◽  
Ankur Khandelwal ◽  
Hirok Roy
Keyword(s):  
Intensive Care Unit ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Intensive Care ◽  
Cervical Spine ◽  
Cervical Spinal Cord ◽  
Cervical Spine Injuries ◽  
Cord Injury ◽  
Spine Injuries ◽  
Dexmedetomidine Infusion

ABSTRACTWe report a 19-year-old male patient, an operated case of anterior cervical discectomy and fusion for traumatic C5–C6 vertebral injury, who developed persistent hypertension following dexmedetomidine infusion in the Intensive Care Unit to enable tolerance of noninvasive ventilation mask. This unusual side effect should be borne in mind when using this drug in patients with cervical spine injuries.

scholarly journals Prolonged Bradycardia, Asystole and Outcome of High Spinal Cord Injury Patients

2014 ◽  
Vol 3 (3) ◽  
pp. 87-92
Author(s):  
Nissar Shaikh ◽  
Ali Raza ◽  
Atur Rahman ◽  
Adel Shabana ◽  
Faisal Malstrome ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Intensive Care ◽  
Injury Severity ◽  
Spinal Injury ◽  
Demographic Data ◽  
Endotracheal Suctioning ◽  
Cord Injury

ABSTRACT High spinal cord injury (HSCI) is one of the devastating traumatic injuries. Majority of these patients are young male and 93% will have major neurological disabilities. The aim of this study was to know the prevalence, risk and precipitating factors for prolonged bradycardia in the HSCI patients. Patients and methods All patients who were admitted to the intensive care unit (ICU) of tertiary hospital, with spinal cord injury above level of dorsal (D4) were enrolled in this study prospectively. Patient's demographic data, mechanism, level and type of spinal injury, associated injuries, injury severity score (ISS), spinal shock, vasopressors used, time of occurrence of bradycardia; precipitating, risk factors and outcome were recorded. Results During the study period, total 138 patients were admitted to the intensive care unit with HSCI. Majority of patients were male. The most frequently associated injury was skeletal fractures (38.4%). Pneumonia in 56 (41%) was the most common complication. Forty-five (33%) patients had prolonged bradycardia; 53.4% had cardiac asystole, 29 (21%) patients had bradycardia during endotracheal suctioning, where, as 27 (20%) patients developed bradycardia at positioning. HSCI patients with prolonged bradycardia had significantly higher, ISS score, ICU and hospitals stay. Multivariate analysis revealed that hypotension on admission; pneumonia and tracheostomy were risk factors for the development of prolonged bradycardia. Conclusion Prolonged bradycardia was associated with significantly higher incidence of asystole. Endotracheal suctioning and positioning of HSCI patients were provocative factors for prolonged bradycardia. Hypotension on admission, pneumonia and tracheostomy were the risk factors for development of prolonged bradycardia. How to cite this article Shaikh N, Raza A, Rahman A, Shabana A, Malstrome F, Al-Sulaiti G. Prolonged Bradycardia, Asystole and Outcome of High Spinal Cord Injury Patients. Panam J Trauma Crit Care Emerg Surg 2014;3(3):87-92.

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