Analysis of the Risk Factors Associated with Prolonged Intubation or Reintubation after Anterior Cervical Spine Surgery

被引:16
作者
Kim, Moinay [1 ]
Rhim, Seung Chul [1 ]
Roh, Sung Woo [1 ]
Jeon, Sang Ryong [1 ]
机构
[1] Univ Ulsan, Asan Med Ctr, Dept Neurol Surg, Coll Med, Ctr 88 Olympic Ro 43 Gil, Seoul 05505, South Korea
关键词
Airway Management; Anterior Cervical Spine Surgery; Extubation; Intubation; Reintubation; EXTUBATION FAILURE; AIRWAY COMPROMISE; COMPLICATIONS; DISKECTOMY; FUSION; DECOMPRESSION; CORPECTOMY;
D O I
10.3346/jkms.2018.33.e77
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Standardized postoperative airway management is essential for patients undergoing anterior cervical spine surgery (ACSS). The paucity of clinical series evaluating these airway complications after ACSS has been resulted in a significant limitation in statistical analyses. Methods: A retrospective cohort study was performed regarding airway distress (intubation for more than 24 hours or unplanned reintubation within 7 days of operation) developed after ACSS. If prevertebral soft tissue swelling was evident after the operation, patients were managed with prolonged intubation (longer than 24 hours). Preoperative and intraoperative patient data, and postoperative outcome (time to extubation and reintubation) were analyzed. Results: Between 2008 and 2016, a total of 400 ACSS were performed. Of them, 389 patients (97.25%) extubated within 24 hours of surgery without airway complication, but 11 patients (2.75%) showed postoperative airway compromise; 7 patients (1.75%) needed prolonged intubation, while 4 patients (1.00%) required unplanned reintubation. The mean time for extubation were 2.75 hours (range: 0-23 hours) and 50.55 hours (range: 0-250 hours), respectively. Age (P= 0.015), diabetes mellitus (P= 0.003), operative time longer than 5 hours (P= 0.048), and estimated blood loss (EBL) greater than 300 mL (P= 0.042) were associated with prolonged intubation or reintubation. In prolonged intubation group, all patients showed no airway distress after extubation. Conclusion: In ACSS, postoperative airway compromise is related to both patients and operative factors. We recommend a prolonged intubation for patients who are exposed to these risk factors to perform a safe and effective extubation.
引用
收藏
页数:9
相关论文
共 21 条
[1]   Adverse Events Associated With Anterior Cervical Spine Surgery [J].
Daniels, Alan H. ;
Riew, K. Daniel ;
Yoo, J. U. ;
Ching, Alexander ;
Birchard, Keith R. ;
Kranenburg, Andy J. ;
Hart, Robert A. .
JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS, 2008, 16 (12) :729-738
[2]   Steroids and Risk Factors for Airway Compromise in Multilevel Cervical Corpectomy Patients A Prospective, Randomized, Double-Blind Study [J].
Emery, Sanford E. ;
Akhavan, Sam ;
Miller, Pam ;
Furey, Christopher G. ;
Yoo, Jung U. ;
Rowbottom, James R. ;
Bohlman, Henry H. .
SPINE, 2009, 34 (03) :229-232
[3]   UPPER-AIRWAY OBSTRUCTION AFTER MULTILEVEL CERVICAL CORPECTOMY FOR MYELOPATHY [J].
EMERY, SE ;
SMITH, MD ;
BOHLMAN, HH .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 1991, 73A (04) :544-551
[4]   Can airway complications following multilevel anterior cervical surgery be avoided? [J].
Epstein, NE ;
Hollingsworth, R ;
Nardi, D ;
Singer, J .
JOURNAL OF NEUROSURGERY, 2001, 94 (02) :185-188
[5]   Anterior cervical Discectomy and fusion associated complications [J].
Fountas, Kostas N. ;
Kapsalaki, Eftychia Z. ;
Nikolakakos, Leonidas G. ;
Smisson, Hugh F. ;
Johnston, Kim W. ;
Grigorian, Arthur A. ;
Lee, Gregory P. ;
Robinson, Joe S. .
SPINE, 2007, 32 (21) :2310-2317
[6]   COMPLICATIONS OF CERVICAL-SPINE SURGERY - A 5-YEAR REPORT ON A SURVEY OF THE MEMBERSHIP OF THE CERVICAL-SPINE-RESEARCH-SOCIETY BY THE MORBIDITY-AND-MORTALITY-COMMITTEE [J].
GRAHAM, JJ .
SPINE, 1989, 14 (10) :1046-1050
[7]   PROLONGED (THERAPEUTIC) ENDOTRACHEAL INTUBATION [J].
HARRISON, GA ;
TONKIN, JP .
BRITISH JOURNAL OF ANAESTHESIA, 1968, 40 (04) :241-+
[8]   Perioperative Complications of Combined Anterior and Posterior Cervical Decompression and Fusion Crossing the Cervico-Thoracic Junction [J].
Hart, Robert A. ;
Tatsumi, Robert L. ;
Hiratzka, Jayme R. ;
Yoo, Jung U. .
SPINE, 2008, 33 (26) :2887-2891
[9]   Relationship between inspiratory muscle strength and cough capacity in cervical spinal cord injured patients [J].
Kang, SW ;
Shin, JC ;
Park, CI ;
Moon, JH ;
Rha, DW ;
Cho, DH .
SPINAL CORD, 2006, 44 (04) :242-248
[10]   Risk factors for delayed extubation after single-stage, multi-level anterior cervical decompression and posterior fusion [J].
Kwon, Brian ;
Yoo, Jung U. ;
Furey, Christopher G. ;
Rowbottom, James ;
Emery, Sanford E. .
JOURNAL OF SPINAL DISORDERS & TECHNIQUES, 2006, 19 (06) :389-393