The intensive care requirements and need for early ventilatory support in patients undergoing emergency and elective spinal surgery

Background

Patients undergoing emergency or elective spinal surgery often require mechanical ventilation for prolonged periods because of their inability to protect their airways, persistence of excessive secretions, and inadequacy of spontaneous ventilation. Tracheostomy plays an integral role in the airway management of such patients; however, its timing still remains subject to considerable practice variation

Study design

A retrospective review of all spinal surgery admissions to the ICU and high dependency unit (HDU) from the National Spinal Injuries Unit (NSIU) at the Mater Misericordiae University Hospital over a 4-year period (n = 152).

Objective

To assess the intensive care requirements of a tertiary referral centre specializing in acute spinal cord injury and diseases of the spine, and to identify risk factors associated with respiratory compromise in the spinal surgery patient.

Methods

A retrospective review of all spinal surgery admissions from the NSIU to the ICU and HDU at the Mater Misericordiae University Hospital between 1 January 2002 and 30 September 2005 (n = 152). The Hospital Inpatient Enquiry System, NSIU and ICU databases were used to identify our study cohort. The medical records, ICU records and the computerized hospital inpatient system were utilized to gather all relevant data. Parameters evaluated included demographics, vertebral level, APACHE II score, forced vital capacity, tracheostomy placement, pneumonia, premorbid pulmonary disease, smoking history, evidence of direct thoracic/lung trauma, operative intervention, associated appendicular trauma, and pre-existing medical comorbidities.

Results

There were 152 spinal admissions to the ICU between 1 January 2002 and 30 September 2005. The average length of stay was 6.6 days (range 1–35 days). Ninety-eight patients were subsequently admitted to the HDU for further intensive management. The average stay for the HDU admissions was 6.5 days (range 1–58 days). Tracheostomies were performed in 36 of these 152 patients (24%). The percentage of high cervical spinal cord injuries was 35% (54/153). We found a significant correlation between high cervical spinal cord injury and respiratory compromise warranting tracheostomy placement, with a relative risk ratio of >1.0.

Conclusion

Several risk factors were identified corresponding to frequent tracheostomy placement in patients undergoing major spinal surgery. Early tracheostomy may be considered in patients with multiple risk factors to reduce the duration of stay in the ICU and facilitate the weaning of ventilatory support.