Abstract
As a referral centre for cervical spine injuries, we have routinely performed awake tracheal intubation when intubation was indicated. A retrospective case control study was undertaken to review the frequency of neurological deterioration and aspiration associated with our approach. Neurological deterioration was assessed by a change in level of injury or neurological grade at admission and discharge. Four hundred and fifty-four patients with critical cervical spine and/or cord injuries were reviewed over an eight-year period. A case group of 165 patients under-went tracheal intubation awake within two months of injury. A control group of 289 remained unintubated during the same period. A comparison of spinal neurological status between admission and discharge revealed no statistically significant difference in neurological deterioration between the two groups. This occurred despite a greater injury severity score in the case group. No evidence of aspiration during intubation was documented. We conclude that awake tracheal intubation is a safe method of airway management in patients with cervical spine injuries.
Résumé
En tant que centre de référence pour les traumatismes du rachis cervical, nous avons effectué de routine des intubations trachéales chez des patients éveillés lorsqu’indiquées. Une étude de dossier rétrospective a été menée afin de reviser la fréquence de détérioration neurologique et d’aspiration associée à notre approche. Une détérioration neurologique était évaluée par un changement dans le niveau du traumatisme ou dans le grade neurologique à l’admission et au depart. Quatre cent cinquantequatre patients avec un traumatisme critique de la moëlle épinière ou du rachis cervical ont été réévalués sur une période de huit ans. Un group étude de 165 patients a subi une intubation trachéale lorsque éveillé en dedans de deux mois du traumatisme. Un groupe contrôle comprenait 289 patients n’ayant pas eu besoin d’intubation pendant la miême période. Une comparaison de l’état neurologique rachidien entre les deux groupes, de l’admission au départ, n’a révélé aucune différence statistiquement significative dans la détérioration neurologique, et ce malgré un pointage de sévérité du traumatisme plus grand dans le groupe étude. Aucune évidence d’aspiration n’a été documentée durant les intubations. Nous en concluons que l’intubation trachéale chez un patient éveillé est une méthode sécuritaire pour contrôler les voies aériennes des patients avec des traumatismes du rachis cervical.
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Meschino, A., Devitt, J.H., Koch, JP. et al. The safety of awake tracheal intubation in cervical spine injury. Can J Anaesth 39, 114–117 (1992). https://doi.org/10.1007/BF03008639
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DOI: https://doi.org/10.1007/BF03008639