A Spinal Cord Injury (SCI) is often associated with damage to any part of the spinal cord or nerves at the end of the spinal canal, causing permanent changes in strength, sensation and other body functions below the site of the injury.
Documented global prevalence of traumatic SCI is insufficient (236–1009 per million). Incidence data was comparable only for regions in North America (39 per million), Western Europe (15 per million) and Australia (16 per million). The major cause of traumatic SCI in these regions involves four-wheeled motor vehicle accidents, in contrast to South-East Asia where two-wheeled (and non-standard) road transport predominates. Southern Asia and Oceania have falls from rooftops and trees as the primary cause1.
At present very few countries in Europe have regional and/or national registers of spinal cord injuries; even in those that do, access to the information recorded is often restricted2.
In the US 1.3 million individuals are currently living with spinal cord injuries3 and the incidence of spinal cord injury has been estimated to be about 40 cases per million per year4&5.
In China, the incidence of spinal cord injury is approximately 60,000 per year6.
Causes of spinal cord injuries include motor vehicle accidents (44%), acts of violence (24%), falls (22%), sports (two-thirds of these are from diving accidents) (8%), and other (2%).
Most people who have spinal cord injuries are male (82%) and the median age at the time of injury is 31.7 years.
The most common cause of death is a respiratory ailment, whereas, in the past it was renal failure.
Chronic/Long-Term Ventilation Indications
Abnormal respiratory function and pulmonary complications are a prominent concern in patients with high-level SCI. Respiratory failure is an independent predictor of 3-month mortality7,8 and pulmonary complications are the leading cause of death and morbidity in patients with SCI9-11. Severity of ventilatory dysfunction after SCI correlates with the level and the completeness of the lesion. In a prospective observational study, the mean duration of mechanical ventilation was 65 days for patients with C1–C4 lesions, 22 days in patients with C5–C8 injury, and 12 days for patients with thoracic injury12.
Complete injury above the C3 level entails apnoeic respiratory arrest and death unless immediate ventilatory assistance is provided13.
Patients with complete cord injuries at the C3 level or above require full ventilator support modes such as controlled mandatory ventilation or assist-control.
Protocols for weaning with progressive ventilatory free breathing should be considered for patients with tetraplegia who are dependent on ventilation.
Each patient must be individually evaluated for the need for long-term ventilation support either acutely or in follow-up. Non-invasive (NIV) support is preferable to invasive ventilation. In fact NIV can be used both in the acute setting and to decannulate/extubate those patients14. Phrenic Nerve Pacing (PNP) is recommended in selected individuals as an alternative to PPV alone.
Regular airway clearance techniques, clinical assessment and ongoing monitoring of pulmonary function is recommended to ensure adequate airway clearance.