A Fast-Track Respiratory Protocol for High Cervical Spine Injury: A Case Report.
Caixue Pan, Yao Chen, Yongfang Zhou
PMID 37937878WHAT IT FOUND
One patient with cervical 5-6 spinal cord injury and severe hypoxemic respiratory failure was weaned the day after tracheostomy on the seventh day during a fast-track respiratory protocol.
This is one case, and no single protocol component's contribution is separable.
Key findings
01The case report recorded PaO2/FiO2 values at these points: 53.5 mmHg on initial mechanical ventilation, 144.2 mmHg after secretion clearance, recruitment maneuvers and positive end-expiratory pressure adjustment, 257 mmHg after 6 hr of airway pressure release ventilation, 244.2 mmHg during pressure support ventilation, and 336.75 mmHg during manual hyperinflation; the paper does not isolate which measures changed them.
02The course included tracheostomy on the seventh day, then successful ventilator weaning the following day while high-flow oxygen via tracheotomy was delivered at flow 45 L/min and inspired oxygen fraction 30%.
03The patient was transferred to the rehabilitation ward on the 25th day and discharged two months later with bilateral shoulder shrug and left upper limb muscle strength at Grade 3.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a single case report, so it describes what happened to one patient and cannot show that the protocol works. There was no control group, randomisation or blinding, so improvement cannot be compared with another group. The patient received many treatments at the same time, including surgery, antibiotics, sedation, analgesia, vasopressor support, secretion clearance, bronchoscopy, different ventilation modes, tracheostomy, high-flow oxygen and manual hyperinflation, so the contribution of any single component cannot be separated. The patient developed mediastinal and subcutaneous emphysema after airway pressure release ventilation, and the ventilation mode was changed. The authors report no long-term follow-up and say their experience is limited for generalization.
Declared interests
The authors declare no conflicts of interest.
The easy way to misread this
Do not read this as evidence that the fast-track respiratory protocol works. It describes one patient and many treatments were given together, so the contribution of any single component cannot be separated.