Preparation for decannulation of children with the consequences of cervical vertebrospinal cord injuries in surgical hospitals

2021 ◽  
Vol 27 (2) ◽  
pp. 115-126
Author(s):  
Irina N. Novoselova ◽  
Irina V. Ponina ◽  
Vladislav A. Machalov ◽  
Svetlana A. Valiullina
Keyword(s):  
Spontaneous Breathing ◽  
Tracheostomy Tube ◽  
Spinal Cord Injuries ◽  
Cervical Spinal Cord ◽  
Early Rehabilitation ◽  
Vital Functions ◽  
Cord Injury ◽  
Rehabilitation Measures ◽  
Group 2 ◽  
Group 1

BACKGROUND: Approximately 40 million people worldwide suffer from vertebrospinal cord injuries every year. According to different authors, children account for 1% to 5% of those injured. The relevance of developing a protocol for preparing children with vertebrospinal cord injuries for decannulation is due to the frequency of respiratory disorders and the peculiarities of the mechanism of their occurrence in patients with cervical spinal cord injuries, the lack of clear recommendations on preparing the patient for decannulation, and early comprehensive rehabilitation measures that contribute to restoring or compensating respiratory, muscular function, and the need for a unique approach to performing rehabilitation measures that consider the age of the child. AIM: This study aims to develop a preparation protocol and an algorithm for decannulation of children with cervical vertebrospinal cord injuries and assess the efficiency of early rehabilitative measures in the preparation process. MATERIALS AND METHODS: This study included 74 children with vertebrospinal cord injuries admitted to the Emergency Childrens Surgery and Traumatology Research Institute from 2014 to 2019. The patients were divided into two groups depending on the time of admission. Group 1 consisted of children admitted to the institute in the acute and early periods of vertebrospinal cord injuries. Group 2 included children in the intermediate and recovery periods. All patients were prepared for spontaneous breathing according to the protocol. RESULTS AND DISCUSSION: Group 1 patients with C2C4 vertebrospinal cord injury levels were decannulated on days 110140 after the injury. One child was diagnosed with an overgrowth of granulations over the tracheostomy tube, which required medical correction followed by successful decannulation. Group 1 patients with C5C8 vertebrospinal cord injury levels were decannulated on days 1541 after the injury. All Group 1 patients underwent early rehabilitation measures, which began immediately after stabilizing vital functions. On days 97110 after the injury, 12 patients of Group 2 with С5С8 vertebrospinal cord injury levels were decannulated. In contrast to Group 1 patients with the same injuries, Group 2 patients did not undergo early rehabilitation measures in primary inpatient settings. Therefore, they required much more time to adapt to spontaneous breathing. CONCLUSIONS: Compliance with the proposed protocol allows determining the patients readiness for decannulation, reduces the risk of potential complications that may arise due to the untimely removal of the tracheostomy tube, increases the effectiveness of rehabilitation measures in this patient category, and reduces the length of the hospital stay. The preparation algorithm for decannulation may serve as a practical guide for specialists involved in treating and rehabilitating children with vertebrospinal cord injuries.

Rehabilitation of patients after spinal cord injury

2020 ◽  
pp. 29-35
Author(s):  
Lev Shlopak
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Injuries ◽  
Vital Functions ◽  
Cord Injury ◽  
Physical Functions ◽  
The Central Nervous System ◽  
Rehabilitation Measures ◽  
Type Of Injury ◽  
Very High

It was not in vain that nature took care of the safety of the central nervous system organs – brain is reliably protected by the bones of the skull and the spinal cord is in a strong bone framework, which is represented by the vertebral column. However in some cases intensity of the received injuries is so pronounced that the vertebrae are unable to protect the spinal cord and this leads to spinal cord injuries. Mortality rate as a result of this type of injury is very high, it depends on the location and degree of damage, timeliness of emergency care and medical capabilities available in the arsenal of a particular healthcare institution. But even if doctors manage to stabilize the patient’s condition, subsequent recovery and prognosis will largely depend on the implemented rehabilitation measures. Here it is important not only to restore the lost physical functions, psychological and social rehabilitation is of great importance, since rhythm and lifestyle are change completely in a patient with such injuries. Crucial point of rehabilitation measures in patients with spinal cord injury is ergotherapy – actions aimed at restoring selfcare skills in order to minimize the degree of dependence on others. Several specialists, the actions of which must be strictly coordinated, should take part in the rehabilitation of patients with a spinal cord injury. The sooner the start of rehabilitation measures is, the greater are the chances for the patient to restore vital functions.

scholarly journals Project BHTRM: new strategy of monitoring and acting in spinal cord injuries in the city of Belo Horizonte

2014 ◽  
Vol 13 (4) ◽  
pp. 322-324
Author(s):  
Diogo Guilherme de Vasconcelos Gonçalves ◽  
Guilherme Zanini Rocha ◽  
José Augusto Malheiros ◽  
Paula Martins ◽  
Aluízio Augusto Arantes Junior ◽  
...  
Keyword(s):  
Public Health ◽  
Spinal Cord Injuries ◽  
Health Management ◽  
Active Monitoring ◽  
Rehabilitation Care ◽  
New Strategy ◽  
Group 2 ◽  
Belo Horizonte ◽  
The City ◽  
Group 1

Objective: The BHTRM Project aims at studying the epidemiology of TRM in the city of Belo Horizonte and providing the means to monitor these patients. Method: To assess the efficacy and solvability of the project, two groups of patients treated at the João XXIII Hospital were compared in two distinct periods. Group 1 - from May 1, 2011 to July 31, 2011, months of project initiation and Group 2 - from December 1, 2012 to February 28, 2013. Results: Despite the 34% increase in the number of assisted patients, there is a 30% drop in the average number of days of hospitalization, as well as a decrease in the average days waiting for surgery of patients requiring surgical treatment, from 10.9 to 4.84, a drop of 56%. Conclusion: BHTRM Project is a useful tool in public health management. It optimizes the treatment of patients with spinal trauma by decreasing the time between admission and surgery. Also provides active monitoring of patient care and ensures better integration of rehabilitation care.

Acupuncture for Treatment of Secondary Osteoporosis in Patients with Spinal Cord Injury: A Controlled Study

2014 ◽  
Vol 32 (5) ◽  
pp. 381-386 ◽  
Author(s):  
Qingxi Meng ◽  
Xin Liu ◽  
Qunqun Shan ◽  
Peng Yu ◽  
Zhaohu Mao ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Combination Therapy ◽  
Bone Mineral ◽  
Secondary Osteoporosis ◽  
Mineral Density ◽  
Cord Injury ◽  
Group 2 ◽  
Group 1

Objective We explored the effect of adjunctive acupuncture on secondary osteoporosis in patients with spinal cord injury (SCI). Methods Patients with subacute SCI were recruited and divided into two groups by patient choice: group 1 patients received standard combination therapy and group 2 patients received combination therapy plus acupuncture for 3 months. The concentrations of IgG, IgM and tumour necrosis factor α (TNFα) in serum and the bone mineral density were measured before and after treatment. Result The decrease in the concentration of TNFα and IgM in patients in group 2 compared with those in group 1 was statistically significant. The IgG level showed no significant change in either group. Bone mineral density increased more after adjunctive acupuncture, but the difference was not significant. Conclusions Further research is needed to determine whether acupuncture as an adjunct to combination therapy can reduce osteoporosis in patients with subacute SCI. Trial Registration Number P153-2008-36

scholarly journals 198. Comparison of Antibiotic Treatment Durations for Symptomatic Bacteriuria in Veterans with Spinal Cord Injuries or Disorders (SCI/D)

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S120-S121
Author(s):  
Michelle Fang ◽  
Scott T Johns ◽  
Ariel Ma
Keyword(s):  
Spinal Cord ◽  
Antibiotic Therapy ◽  
Hospital Admission ◽  
Antibiotic Treatment ◽  
Statistical Tests ◽  
Treatment Completion ◽  
Cord Injury ◽  
Group 2 ◽  
Tract Infections ◽  
Group 1

Abstract Background It is unclear based on published literature whether shorter courses of antibiotic treatment may be appropriate for urinary tract infections (UTI) in patients with SCI/D given their complex baseline clinical status. Methods This retrospective cohort study was conducted at the VA San Diego Healthcare System (VASDHS), which has a dedicated SCI/D unit. Adults with SCI/D were identified for inclusion if they had received antibiotics for a positive urine culture in conjunction with UTI symptoms from 1/2018-12/2020. Individual UTI events were excluded if associated with potential sources of harbored infection, anatomic abnormalities increasing risk of bacteriuria, non-bacterial pathogens, concurrent infections prolonging antibiotic treatment, or antibiotic courses managed outside of VASDHS. Treatment groups comprised UTI events treated with no more than 7 days of antibiotics (group 1) versus more than 7 days (group 2). Study endpoints were recurrence or new incidence of UTI within 30 and 90 days after completion of antibiotic treatment and onset of C. difficile infection or death within 30 or 90 days, respectively, after treatment completion. Statistical tests included Chi-square, Mann-Whitney U, and logistic regression. Results One-hundred and seven patients with 241 unique UTI events were included in this study, with 79 events in group 1 and 162 events in group 2. Baseline characteristics were similar across both groups, aside from a higher incidence of hospital admission and more severe SCI/D based on the American Spinal Cord Injury Association (ASIA) impairment scale in group 2. Efficacy outcomes are described in Table 1. No deaths occurred within 90 days of treatment completion, and C. difficile infection occurred in 1 patient in group 2 after 3 days of antibiotic therapy. Duration of antibiotic therapy was not predictive of treatment failure within 30 days of antibiotic completion. Factors predictive of treatment with longer courses of antibiotic therapy included hospital admission and more severe ASIA impairment scale score. Table 1. Incidence of UTI after antibiotic completion Conclusion The findings of this study suggest that for some patients with SCI/D, UTI treatment lasting 7 days or fewer may be effective compared to longer courses of antibiotics and could be beneficial in reducing collateral damage from antibiotic use. Disclosures All Authors: No reported disclosures

scholarly journals Comparison of the conventional frozen elephant trunk implantation technique with a modified implantation technique in zone 1

2019 ◽  
Author(s):  
Roman Gottardi ◽  
Andreas Voetsch ◽  
Philip Krombholz-Reindl ◽  
Andreas Winkler ◽  
Johannes Steindl ◽  
...  
Keyword(s):  
Circulatory Arrest ◽  
Implantation Technique ◽  
P Value ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Aortic Cross Clamp Time ◽  
Cord Injury ◽  
Group 2 ◽  
Aortic Anastomosis ◽  
Group 1

Abstract OBJECTIVES The aim of the study was to compare the conventional frozen elephant trunk implantation technique with a modified implantation technique with an aortic anastomosis in zone 1 and extra-anatomic revascularization of the left subclavian artery during reperfusion. METHODS Between May 2014 and March 2018, 40 patients (26 male; mean age 60.2 ± 11.2 years) underwent complete aortic arch replacement with the Thoraflex Hybrid prosthesis™ (Vascutek, Inchinnan, Scotland) at our institution. Seventeen patients underwent conventional arch replacement (group 1) and 23 patients the modified procedure (group 2). Indication for arch replacement included all types of acute and chronic diseases. RESULTS Cardiopulmonary bypass time (213.1 ± 53.5 vs 243.8 ± 67.0 min, P = 0.13) and aortic cross-clamp time (114.4 ± 40.7 vs 117.3 ± 56.6 min, P = 0.86) did not differ significantly between group 1 and 2. There was a trend towards a shorter circulatory arrest time (50.72 ± 9.6 vs 44.7 ± 15.5 min; P = 0.20) in group 2. Perioperative mortality was 10% (5.9% vs 13%; P = 0.62). Stroke occurred in 10% (5.9% vs 13%; P = 0.62) of patients. Spinal cord injury occurred in 7.5% of patients (11.8% vs 4.3% P = 0.57). Due to the a proximal aortic anastomosis, there was a significantly shorter coverage of the descending aorta with the prosthesis ending at vertebral level Th7.5 (6.75–8) in group 1 versus Th6.0 (5.0–6.0) in group 2 (P-value = 0.004). CONCLUSIONS Implantation of the frozen elephant trunk prosthesis in zone 1 allows for a more proximal aortic anastomosis that could make the procedure more feasible especially in patients with difficult anatomies or in an acute setting.

Recurrent Asystole Resulting from High Cervical Spinal Cord Injuries

2006 ◽  
Vol 72 (6) ◽  
pp. 525-529 ◽  
Author(s):  
D.L. Franga ◽  
M.L. Hawkins ◽  
R.S. Medeiros ◽  
D. Adewumi
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Cervical Spinal Cord ◽  
Cardiac Pacemakers ◽  
Cord Injury ◽  
Pacemaker Placement ◽  
Level I ◽  
High Cervical ◽  
Short Time ◽  
Injured Patients

Cervical spinal cord injury is a highly morbid condition frequently associated with cardiovascular instability. This instability may include bradyarrhythmias, as well as hypotension, and usually resolves in a relatively short time. However, over a 3-year period (January 2003–December, 2005), 5 of 30 patients with complete cervical spinal cord injuries seen at our Level I trauma center required placement of permanent cardiac pacemakers for recurrent bradycardia/asystolic events. Strong consideration for pacemaker placement should be given for those spinal cord-injured patients with symptomatic bradyarrhythmic events still occurring 2 weeks after injury.

scholarly journals Longitudinal changes in DTI parameters of specific spinal white matter tracts correlate with behavior following spinal cord injury in monkeys

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Arabinda Mishra ◽  
Feng Wang ◽  
Li Min Chen ◽  
John C. Gore
Keyword(s):  
Spinal Cord ◽  
White Matter ◽  
Spinal Cord Injuries ◽  
Diffusion Tensor ◽  
Cervical Spinal Cord ◽  
Human Subjects ◽  
Realistic Model ◽  
White Matter Tracts ◽  
Injured Side ◽  
Cord Injury

Abstract This study aims to evaluate how parameters derived from diffusion tensor imaging reflect axonal disruption and demyelination in specific white matter tracts within the spinal cord of squirrel monkeys following traumatic injuries, and their relationships to function and behavior. After a unilateral section of the dorsal white matter tract of the cervical spinal cord, we found that both lesioned dorsal and intact lateral tracts on the lesion side exhibited prominent disruptions in fiber orientation, integrity and myelination. The degrees of pathological changes were significantly more severe in segments below the lesion than above. The lateral tract on the opposite (non-injured) side was minimally affected by the injury. Over time, RD, FA, and AD values of the dorsal and lateral tracts on the injured side closely tracked measurements of the behavioral recovery. This unilateral section of the dorsal spinal tract provides a realistic model in which axonal disruption and demyelination occur together in the cord. Our data show that specific tract and segmental FA and RD values are sensitive to the effects of injury and reflect specific behavioral changes, indicating their potential as relevant indicators of recovery or for assessing treatment outcomes. These observations have translational value for guiding future studies of human subjects with spinal cord injuries.

scholarly journals Insertion of magnetically controlled growing rods in a patient with a diaphragmatic pacemaker: case report

2017 ◽  
Vol 43 (4) ◽  
pp. E14 ◽  
Author(s):  
Andrew C. Vivas ◽  
Steven W. Hwang ◽  
Joshua M. Pahys
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Muscle Tone ◽  
Cervical Spinal Cord ◽  
Young Patients ◽  
Growing Rods ◽  
Growing Rod ◽  
Cord Injury ◽  
High Cervical ◽  
Magnetically Controlled Growing Rods

Phrenic stimulators offer an alternative to standard mechanical ventilation as well as the potential for ventilator independence in select patients with chronic respiratory failure. Young patients (< 10 years old) with high cervical spinal cord injuries often develop paralytic scoliosis due to loss of muscle tone caudal to their spinal cord lesion. Growing rod systems allow for stabilization of spinal deformity while permitting continued growth of the spine and thoracic cavity. Magnetically controlled growing rods (MCGRs) offer the advantage of noninvasive expansion, as opposed to the operative expansion required in traditional growing rod systems. To the authors’ knowledge, this is the first reported case of MCGRs in a patient with a diaphragmatic pacemaker (DP). A 7-year-old boy with ventilator dependence after a high cervical spinal cord injury presented to the authors’ institution with paralytic scoliosis that progressed to > 120°. The patient had previously undergone insertion of phrenic nerve stimulators for diaphragmatic pacing. The decision was made to insert MCGRs bilaterally to stabilize his deformity, because the planned lengthening surgeries that are necessary with traditional growing rods would be poorly tolerated in this patient. The patient’s surgery and postoperative course were uneventful. The DP remained functional after insertion and lengthening of the MCGRs by using the external magnet. The DP had no effect on the expansion capability of the MCGRs. In conclusion, the MCGRs appear to be compatible with the DP. Further studies are needed to validate the long-term safety and compatibility of these 2 devices.

scholarly journals Combined medical and surgical treatment after acute spinal cord injury: results of a prospective pilot study to assess the merits of aggressive medical resuscitation and blood pressure management

1999 ◽  
Vol 6 (1) ◽  
pp. E6 ◽  
Author(s):  
Fernando L. Vale ◽  
Jennifer Burns ◽  
Amie B. Jackson ◽  
Mark N. Hadley
Keyword(s):  
Blood Pressure ◽  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Cervical Spinal Cord ◽  
Bladder Function ◽  
Thoracic Spinal Cord ◽  
Arterial Blood ◽  
Thoracic Spinal ◽  
Cord Injury

The optimal management of acute spinal cord injuries remains to be defined. The authors prospectively applied resuscitation principles of volume expansion and blood pressure maintenance to 77 patients who presented with acute neurological deficits as a result of spinal cord injuries occurring from C-1 through T-12 in an effort to maintain spinal cord blood flow and prevent secondary injury. According to the Intensive Care Unit protocol, all patients were managed by Swan-Ganz and arterial blood pressure catheters and were treated with immobilization and fracture reduction as indicated. Intravenous fluids, colloid, and vasopressors were administered as necessary to maintain mean arterial blood pressure above 85 mm Hg. Surgery was performed for decompression and stabilization, and fusion in selected cases. Sixty-four patients have been followed at least 12 months postinjury by means of detailed neurological assessments and functional ability evaluations. Sixty percent of patients with complete cervical spinal cord injuries improved at least one Frankel or American Spinal Injury Association (ASIA) grade at the last follow-up review. Thirty percent regained the ability to walk and 20% had return of bladder function 1 year postinjury. Thirty-three percent of the patients with complete thoracic spinal cord injuries improved at least one Frankel or ASIA grade. Approximately 10% of the patients regained the ability to walk and had return of bladder function. As of the 12-month follow-up review, 92% of patients demonstrated clinical improvement after sustaining incomplete cervical spinal cord injuries compared to their initial neurological status. Ninety-two percent regained the ability to walk and 88% regained bladder function. Eighty-eight percent of patients with incomplete thoracic spinal cord injuries demonstrated significant improvements in neurological function 1 year postinjury. Eighty-eight percent were able to walk and 63% had return of bladder function. The authors conclude that the enhanced neurological outcome that was observed in patients after spinal cord injury in this study was in addition to, and/or distinct from, any potential benefit provided by surgery. Early and aggressive medical management (volume resuscitation and blood pressure augmentation) of patients with acute spinal cord injuries optimizes the potential for neurological recovery after sustaining trauma.

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