Respiratory Disorders in Complicated Cervical Spine Injury

Objective. Evaluating the results of respiratory therapy in patients with complicated traumatic injury of the cervical spine.

Materials and methods. A retrospective comparative analysis of the clinical course was carried out in 52 patients with complicated traumatic injury of the cervical spine: group A: complete spinal cord injury (ASIA A), 37 patients and group B: incomplete injury (ASIA B), 15 patients. The severity of patients' status on integral scales, parameters of the respiratory pattern and thoracopulmonary compliance, gas composition, and acidbase status of the blood were assessed. Data on patients who required prolonged mechanical ventilation, duration of mechanical ventilation, incidence of nosocomial pneumonia, duration of stay in the ICU, time of hospital treatment, and mortality were included in the analysis.

Results. The average APACHE II and SOFA scores were higher in group A patients. The development of the acute respiratory failure required longterm mechanical ventilation (more than 48 hours) in 91.4% of group A patients and in 53.3% of group B patients. Ventilatorassociated pneumonia complicated the disease in 81.3% of group A patients and 62.5% of group B patients and was accompanied by sepsis in 25% and 12.5% of cases, respectively. Statistically significant deterioration of biomechanical properties and gas exchange function of the lungs was observed in patients complicated with septic pneumonia.

Conclusion. Patients with complicated ASIA A and ASIA B cervical spine injuries demonstrate the presence of respiratory failure of neurogenic origin. In addition, the infectious bronchopulmonary complications aggravated respiratory failure in patients with ASIA A injury in 70.3% versus 33.3% in patients with ASIA B. Development
of pulmonogenic sepsis led to deterioration of the biomechanical and gas exchange functions of the lungs and increased the likelihood of unfavorable outcome of the disease in 77.8% of cases. The high incidence of respiratory disorders in patients with complicated cervical spine injury requires timely decision on ventilatory support, especially in patients with complete spinal cord injury.

1. Rerikh V.V., Lastevsky A.D. Khirurgicheskoe lechenie povrezhdenii nizhnesheinogo otdela pozvonochnika. [Surgery for lower cervical spine injuries]. Khirurgiya Pozvonochnika. 2007; 1: 13–20. [In Russ.]

2. Lutsik A.A., Rerikh V.V., Bondarenko G.Yu., Karpenko V.S. Pozvonochnospinnomozgovaya travma (klassifikatsionnaya kharak teristika, khirurgicheskoe lechenie). Uchebnoe posobie. [Spinal trauma (classification, surgical treatment). Manual]. Novokuznetsk: Vyssheye Obrazovanie; 2011. [In Russ.]

3. Gelfand B.R., Saltanov A.I. (red.). Intensivnaya terapiya. Natsionalnoe rukovodstvo. [Intensive therapy. National manual]. Moscow: GEO TARMedia; 2009. [In Russ.]

4. Barinov A.N., Kondakov E.N., Yakovenko I.V. Vyzhivaemost i letalnost pri ostroi pozvonochnospinnomozgovoi travme v Arkhangelskoi oblasti. [Survival and lethality in acute vertebralcerebrospinal injuries in Arkhangelsk Region]. Ekologiya Cheloveka. 2011; 8: 51–55. [In Russ.]

5. Barinov A.N., Kondakov E.N. Organizatsiya pomoshchi postradavshim s pozvonochnospinnomozgovoi travmoi v Arkhangelskoi oblasti. [Health care organization for patients with spinal trauma in the Arkhangelsk Region]. Neirokhirurgiya. 2011; 3: 73–78. [In Russ.]

6. Osintsev V.V., Khudyaev A.T. Analiz letalnosti pri povrezhdeniyakh sheinogo otdela pozvonochnika. [The lethality analysis for injuries of the cervical spine]. Genii Ortopedii. 2003; 2: 80–81. [In Russ.]

7. Hassid V.J., Schinco M.A., Tepas J.J., Griffen M.M., Murphy T.L., Frykberg E.R., Kerwin A.J. Definitive establishment of airway control is critical for optimal outcome in lower cervical spinal cord injury. J. Trauma. 2008; 65 (6): 1328–1332. http://dx.doi.org/10.1097/TA.0b013e31818d07e4.PMID: 19077622

8. Berlly M., Shem K. Respiratory management during the first five days after spinal cord injury. J. Spinal Cord Med. 2007; 30 (4): 309–318. PMID: 17853652

9. Ryken T.C., Hurlbert R.J., Hadley M.N., Aarabi B., Dhall S.S., Gelb D.E., Rozzelle C.J., Theodore N., Walters B.C. The acute cardiopulmonary management of patients with cervical spinal cord injuries. Neurosurgery. 2013; 72 (Suppl 2): 84–92. http://dx.doi.org/10.1227/NEU.0b013e318276ee16. PMID: 23417181

10. Como J.J., Sutton E.R., McCunn M., Dutton R.P., Johnson S.B., Aarabi B., Scalea T.M. Characterizing the need for mechanical ventilation follow ing cervical spinal cord injury with neurologic deficit. J. Trauma. 2005; 59 (4): 912–916. http://dx.doi.org/10.1097/01.ta.0000187660.03742.a6. PMID: 16374281

11. Berney S.C., Gordon I.R., Opdam H.I., Denehy L. A classification and regression tree to assist clinical decision making in airway management for patients with cervical spinal cord injury. Spinal Cord. 2011; 49 (2): 244–250. http://dx.doi.org/10.1038/sc.2010.97. PMID: 20697418

12. Berney S., Bragge P., Granger C., Opdam H., Denehy L. The acute respiratory management of cervical spinal cord injury in the first 6 weeks after injury: a systematic review. Spinal Cord. 2011; 49 (1): 17–29. http://dx.doi.org/10.1038/sc.2010.39. PMID: 20404832

13. Casha S., Christie S. A systematic review of intensive cardiopulmonary management after spinal cord injury. J. Neurotrauma. 2011; 28 (8): 1479–1495. http://dx.doi.org/10.1089/neu.2009.1156. PMID: 20030558

14. Lebedinsky K.M., Mazurok V.A., Nefedov A.V. Osnovy respiratornoi podderzhki. [Basics of respiratory support]. SanktPeterburg: Chelovek; 2008: 208. [In Russ.]

15. Ford P., Teron A. Povrezhdeniya sheinogo otdela pozvonochnika. V kn.: Nedashkovsky E.V., Kuzkov V.V. (red.). Osnovy intensivnoi terapii. [Cervival spinal trauma. In: Nedashkovsky E.V., Kuzkov V.V. (eds.). Basics of intensive therapy]. Severodvinsk; 2014: 197–209. [In Russ.]

16. Bazhanov S.P., Ulyanov V.Yu., Makarkina E.V., Ostrovsky V.V., Norkin I.A., Shchukovsky V.V. Multidistsiplinarnyi podkhod v profilaktike i lechenii bronkholegochnykh oslozhnenii v ostrom periode mnogourovnevoi nestabilnoi travmy sheinogo otdela pozvonochnika i spinnogo mozga. [A multidisciplinary approach to prevention and treatment of bronchopulmonary complications in the acute period of multilevel unstable cervical spine and spinal cord injury]. Khirurgiya Pozvonochnika. 2012; 3: 67–71. [In Russ.]

17. Norkin I.A., Shchukovsky V.V., Ulyanov V.Yu., Makarkina E.V., Ostrovsky V.V. Klinicheskie osobennosti i taktika lecheniya patsientov s bronk holegochnymi oslozhneniyami v ostrom i rannem periodakh pozvonochnospinnomozgovoi travmy. [Clinical features and treatment approach for patients with bronchopulmonary complications in acute and early periods of the spine and spinal cord injury]. Khirurgiya Pozvonochnika. 2009; 3: 75–78. [In Russ.]

18. Ulyanov V.Yu., Norkin I.A., Makarkina E.V., Shchukovsky V.V. Antibakterialnaya terapiya bronkholegochnykh oslozhnenii u patsientov s travmoi sheinogo otdela pozvonochnika. [Antibacterial therapy of bronchopulmonary complications]. Khirurgiya Pozvonochnika. 2010; 3: 72–76. [In Russ.]

19. Dementyeva I.I. Klinicheskie aspekty sostoyaniya i regulyatsii kislot noosnovnogo gomeostaza. [Clinical aspects of acidbase state and regulation]. Moscow: UNIMEDpress; 2002: 80. [In Russ.]

20. Lukyanov D.S., Lebedeva M.N., Rakhmatilaev Sh.N., Shevchenko V.P., Rerikh V.V. Osobennosti gazoobmena v khode mnogoetapnykh khirur gicheskikh vmeshatelstv pri travmaticheskikh povrezhdeniyakh pozvonochnika. [Features of gas exchange during multistage surgical intervention for traumatic spine injury]. Khirurgiya Pozvonochnika. 2012; 2: 79–86. [In Russ.]

21. Chuchalin A.G., Gelfand B.R. (red.). Nozokomialnaya pnevmoniya u vzroslykh. Rossiiskie natsionalnye rekomendatsii. [Nosocomial pneumonia in adults. Russian national guidelines]. Moscow; 2009: 92. [In Russ.]

22. Egorova N.I., Vlasenko A.V., Moroz V.V., Yakovlev V.N., Alekseyev V.G. Ventilyatorassotsiirovannaya pnevmoniya: diagnostika, profilaktika, lechenie (sovremennoe sostoyanie voprosa). Obshchaya Reanimatologiya. [Ventilatorassociated pneumonia: diagnosis, prevention, treatment (stateoftheart of the problem). General

23. Reanimatology]. 2010; 6 (1): 79–88. http://dx.doi.org/10.15360/1813 97792010179. [In Russ.]

24. Savelyev V.S., Gelfand B.R. Sepsis v nachale XXI veka. Klassifikatsiya, klinikodiagnosticheskaya kontseptsiya i lechenie. Patologo anatomicheskaya diagnostika. [Sepsis in the beginning of 21st century. Classification, diagnosis and treatment. Pathological diagnostics]. Moscow: Litterra; 2006: 176. [In Russ.]

25. Moroz V.V., Lukach V.N., Shifman E.N., Dolgikh V.T., Yakovleva V.I. Sepsis: klinikopatofiziologicheskie aspekty intensivnoi terapii. Rukovodstvo dlya vrachei. [Sepsis: clinical and pathological aspects of intensive therapy. Manual for physicians]. Petrozavodsk: IntelTek; 2004: 291. [In Russ.]

26. Moroz V.V., Vlasenko A.V., Golubev A.M. ORDSpatogenez i terapevticheskie misheni. [Pathogenesis and target therapy of acute respiratory distress syndrome]. Anesteziologiya i Reanimatologiya. 2014; 59 (4): 45–52. PMID: 25549486. [In Russ.]

27. Yaroshetsky A.I., Protsenko D.N., Rezepov N.A., Gelfand B.R. Nastroika polozhitelnogo davleniya kontsa vydokha pri parenkhimatoznoi ODN: staticheskaya petlya «davlenieobyem» ili transpulmonalnoe davlenie? [Positive endexpiratory pressure adjustment in parenchimal respiratory failure: static pressurevolume loop or transpulmonary pressure?]. Anesteziologiya i Reanimatologiya. 2014; 59 (4): 53–59. PMID: 25549487. [In Russ.]

28. Vyzhigina M.A., Mizikov V.M., Sandrikov V.A., Lukyanov M.V., Titov V.A., Zhukova S.G., Parshin V.D., Ryabova O.S., Kurilova O.A., Alekseyev A.V., Bunyatyan A.A. Sovremennye osobennosti respiratornogo obespecheniya v torakalnoi khirurgii. Traditsionnye problemy i innovatsionnye resheniya (opyt bolee 2 tysyach anestezii). [Respiratory support in anaesthetic management for thoracic surgery and their comparative characteristics: over 2000 anaesthesia experience]. Anesteziologiya i Reanimatologiya. 2013; 58 (2): 34–40. PMID: 24000649. [In Russ.]