The impact of tracheostomy timing on the outcomes of patients with acute traumatic spinal cord injury: A systematic review and meta-analysis

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-05-18 DOI:10.1016/j.clineuro.2025.108968

Negin Zameni , Masoud Khoshnoodi , Brandon Lucke-Wold , James S. Harrop , Armin Karamian

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引用次数: 0

Abstract

Background

Spinal cord injury (SCI) can cause serious respiratory problems. Cervical high-level injuries may result in diaphragm paralysis, necessitating tracheostomy to assist airway protection and facilitate breathing.

Methods

A comprehensive literature search of PubMed, Google Scholar, and Web of Science was performed for published studies comparing outcomes between early versus late tracheostomy in acute traumatic SCI patients.

Results

The initial search returned 1837 articles, after the final review, 17 studies with a total of 3853 patients were included in the meta-analysis. The mortality rate between early and late tracheostomy was not statistically significant (OR = 0.81, 95 % CI = [0.37, 1.78], P = 0.61). However, early tracheostomy was associated with reduced duration of mechanical ventilation (MD = − 10.58, 95 % CI = [−15.22, −5.95], P < 0.01), hospital length of stay (MD = − 8.50, 95 % CI = [−10.95, −6.05], P < 0.01), and ICU length of stay (MD = − 9.12, 95 % CI = [−12.20, −6.05], P < 0.01). Early tracheostomy was also associated with a lower incidence of pneumonia (OR = 0.68, 95 % CI = [0.51, 0.91], P < 0.01). Patients in the early tracheostomy group also experienced fewer tracheostomy-related complications (OR = 0.50, 95 % CI = [0.33, 0.75], P < 0.01).

Conclusion

In patients with acute traumatic SCI, early tracheostomy within seven days of injury, surgery, or intubation is associated with reduced duration of mechanical ventilation, and length of stay in the hospital and ICU. Early tracheostomy is also associated with a lower risk of tracheostomy-related complications.

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气管切开术时机对急性创伤性脊髓损伤患者预后的影响：一项系统回顾和荟萃分析

背景：脊髓损伤（SCI）可引起严重的呼吸问题。颈椎高位损伤可导致横膈膜麻痹，需要气管切开术以辅助气道保护和促进呼吸。方法综合检索PubMed、b谷歌Scholar和Web of Science的文献，比较急性创伤性脊髓损伤患者早期与晚期气管切开术的疗效。结果初始检索返回1837篇文章，最终审查后，17项研究共3853例患者被纳入meta分析。早期和晚期气管切开术患者的死亡率差异无统计学意义（OR = 0.81, 95 % CI = [0.37, 1.78], P = 0.61）。然而,早期气管造口术的持续时间降低机械通气(MD =−10.58,95 % CI =−15.22−5.95,P & lt; 0.01),医院住院时间(MD =−8.50,95 % CI =−10.95−6.05,P & lt; 0.01),和ICU住院时间(MD =−9.12,95 % CI =−12.20−6.05,P & lt; 0.01)。早期气管切开术也与较低的肺炎发生率相关（OR = 0.68, 95 % CI = [0.51, 0.91], P <； 0.01）。早期气管造口组患者出现的气管造口相关并发症也较少（OR = 0.50, 95 % CI = [0.33, 0.75], P <； 0.01）。结论急性外伤性脊髓损伤患者在损伤、手术或插管后7天内早期气管切开术可减少机械通气时间、住院时间和ICU时间。早期气管切开术也与气管切开术相关并发症的风险较低有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.