The respiratory approach to the medullary patient in the acute stage, from literature to experience

Abstract

In spinal cord injury in the acute phase, pulmonary complications are the most common cause of death and often affect the outcome even during the chronic phase. In the initial acute phase, the person is assisted in ICU and the management of the airways can be guaranteed in two ways: invasive by subjecting the patient to tracheotomy and invasive ventilation, non-invasive by extubating the patient early, supporting him with Non-Invasive Ventilation ( NIV). Both approaches have their advantages and disadvantages. For about 6 years in the Intensive Therapy of the Neuromotor Pole (Sod neuroanesthesia and Reanimation) Careggi hospital in Florence has been strengthened 54 patients with complete or incomplete spinal cord injury, resulting from trauma, have been hospitalized only 23 patients (less than 43%) have needed tracheostomy. Those who did not have the tracheostomy performed NIV in the early stages, and then moved on to more autonomous ventilatory modes. All patients were treated with a mechanical cough assistant. From the retrospective investigation it appears that NIV can be considered a valid alternative to invasive ventilation in the bone marrow patient. However, it is necessary to specify that the desired objectives can only be achieved with solid knowledge of the health professionals involved and above all by close collaboration within the multidisciplinary team. The non-invasive approach has reduced complications for the patient, hospitalization times with a consequent reduction in treatment costs. In light of the data that emerged and the considerations made, we can think that this is only the beginning of a multidisciplinary path that reduces the invasive approach on our clients as much as possible.