Risk Factors Relating to the Need for Mechanical Ventilation in Isolated Cervical Spinal Cord Injury Patients
Thamrong Lertudomphonwanit MD*, Thanet Wattanaapisit MD*, Cholavech Chavasiri MD*, Areesak Chotivichit MD*
Affiliation : * Department of Orthopedics Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Cervical spinal cord injuries (SCI) are a major public health problem. Respiratory complications are among
the most important causes of morbidity and mortality in patients with cervical SCI, especially respiratory failure. Based on
our evaluation of the existing English language literature, few previous studies appear to have reported on risk factors
associated with the need for mechanical ventilation in isolated cervical SCI patients who had no concomitant injuries or
diseases at the time of admission.
Objective : The purpose of this study was to determine incidence and risk factors relating to the need for mechanical ventilation
in isolated cervical spinal cord injury (SCI) patients who had no concomitant injuries.
Material and Method: This retrospective study was conducted by reviewing and analyzing the patient data of 66 isolated
cervical-SCI patients who were admitted in our hospital between January 1995 and December 2009. Patient medical records
were reviewed for demographic data, neurological injuries, need for mechanical ventilation, definitive treatment, complications,
and outcomes. Univariate and multivariate analysis were used to identify predisposing risk factors relating to patient
dependency on mechanical ventilation.
Results : Of the 66 patients, 30.3% (20/66) required mechanical ventilation and 22.7% (15/66) were identified as complete
cord injury, of which seven sustained injury above C5. Of the patients with complete SCI, 66.7% (10/15) were dependent on
mechanical ventilation, as were 85% (6/7) with SCI above C5. All five of the patients with complete-SCI above C5 who
received operative treatment were dependent upon mechanical ventilation, postoperatively. Only 19.6% (10/51) of the
incomplete injury group required mechanical ventilation.
Univariate analysis indicated the following factors as significantly increasing the risk of ventilator dependence:
complete SCI (p = 0.001), SCI above C5 level (p = 0.011) and operative treatment (p = 0.008). Multivariate analysis identified
the following factors as being predisposing risk factors relating to the need of mechanical ventilation: complete SCI (OR:
12.8; 95% CI 2.4-66.9; p = 0.003), SCI above C5 level (OR: 12.0; 95% CI 2.4-60.2; p = 0.002), and operative treatment
(OR: 14.8; 95% CI 2.1-106.9; p = 0.008).
Conclusion : Complete SCI, SCI above C5, and operative treatment were predisposing risk factors relating to the need for
mechanical ventilation in isolated cervical SCI patients. The data and findings put forth in this study suggest that these factors
may assist in predicting the need for mechanical ventilation as a long-term treatment for isolated cervical SCI patients.
Keywords : Cervical spinal cord injury, Mechanical ventilation, Respiratory failure
