Preparation for decannulation of children with the consequences of cervical vertebrospinal cord injuries in surgical hospitals

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Abstract

BACKGROUND: Approximately 40 million people worldwide suffer from vertebrospinal cord injuries every year. According to different authors, children account for 1% to 5% of those injured. The relevance of developing a protocol for preparing children with vertebrospinal cord injuries for decannulation is due to the frequency of respiratory disorders and the peculiarities of the mechanism of their occurrence in patients with cervical spinal cord injuries, the lack of clear recommendations on preparing the patient for decannulation, and early comprehensive rehabilitation measures that contribute to restoring or compensating respiratory, muscular function, and the need for a unique approach to performing rehabilitation measures that consider the age of the child.

AIM: This study aims to develop a preparation protocol and an algorithm for decannulation of children with cervical vertebrospinal cord injuries and assess the efficiency of early rehabilitative measures in the preparation process.

MATERIALS AND METHODS: This study included 74 children with vertebrospinal cord injuries admitted to the Emergency Children’s Surgery and Traumatology Research Institute from 2014 to 2019. The patients were divided into two groups depending on the time of admission. Group 1 consisted of children admitted to the institute in the acute and early periods of vertebrospinal cord injuries. Group 2 included children in the intermediate and recovery periods. All patients were prepared for spontaneous breathing according to the protocol.

RESULTS AND DISCUSSION: Group 1 patients with C2–C4 vertebrospinal cord injury levels were decannulated on days 110–140 after the injury. One child was diagnosed with an overgrowth of granulations over the tracheostomy tube, which required medical correction followed by successful decannulation. Group 1 patients with C5–C8 vertebrospinal cord injury levels were decannulated on days 15–41 after the injury. All Group 1 patients underwent early rehabilitation measures, which began immediately after stabilizing vital functions.

On days 97–110 after the injury, 12 patients of Group 2 with С5–С8 vertebrospinal cord injury levels were decannulated. In contrast to Group 1 patients with the same injuries, Group 2 patients did not undergo early rehabilitation measures in primary inpatient settings. Therefore, they required much more time to adapt to spontaneous breathing.

CONCLUSIONS: Compliance with the proposed protocol allows determining the patient’s readiness for decannulation, reduces the risk of potential complications that may arise due to the untimely removal of the tracheostomy tube, increases the effectiveness of rehabilitation measures in this patient category, and reduces the length of the hospital stay. The preparation algorithm for decannulation may serve as a practical guide for specialists involved in treating and rehabilitating children with vertebrospinal cord injuries.

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About the authors

Irina N. Novoselova

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma

Author for correspondence.
Email: i.n.novoselova@gmail.com
ORCID iD: 0000-0003-2258-2913
SPIN-code: 1406-1334

MD, Cand. Sci. (Med.)

Russian Federation, 22 Bol’shaya Polyanka str., 119180, Moscow

Irina V. Ponina

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma

Email: ponina.irina@mail.ru
ORCID iD: 0000-0002-0060-7895
SPIN-code: 1753-6156
Russian Federation, 22 Bol’shaya Polyanka str., 119180, Moscow

Vladislav A. Machalov

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma

Email: vmachalov@gmail.com
ORCID iD: 0000-0003-4680-2044
SPIN-code: 3425-7011
Russian Federation, 22 Bol’shaya Polyanka str., 119180, Moscow

Svetlana A. Valiullina

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma

Email: vsa64@mail.ru
ORCID iD: 0000-0002-1622-0169
SPIN-code: 6652-2374

MD, Dr. Sci. (Med.), Professor

Russian Federation, 22 Bol’shaya Polyanka str., 119180, Moscow

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Supplementary files

Supplementary Files
Action
1. Fig. 1. Day 2 after the spinal cord injury at the C3 cervical level. Ensuring adequate breathing and prevention of respiratory complications.

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2. Fig. 2. Early verticalization and creation of conditions for spontaneous functional recovery. Abdominal support during verticalization to create adequate intra-abdominal pressure.

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3. Fig. 3. Breathing trainer with adjustable airflow resistance.

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4. Fig. 4. Decannulation algorithm for patients with cervical spinal cord injuries.

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