An intermediate respiratory care unit for spinal cord-injured patients. A retrospective study.

OBJECTIVES: Patients with cervical spinal cord injury (SCI) may need prolonged mechanical ventilation (MV) and a long stay in the Intensive Care Unit. An intermediate respiratory care unit (IRCU) can shorten that stay, optimizing hospital resources. The aim of our work has been to evaluate the activity of such a unit in our hospital. METHODS: This is a descriptive retrospective study based on the data of patients with SCI and respiratory failure discharged from our IRCU between 1 July 2010 and 28 February 2013. RESULTS: We have analysed data from 146 patients with SCI, adding up to 228 admissions (68 first admissions and 160 readmissions due to complications or scheduled review visits). Sixty-three out of the 68 newly admitted patients survived their first admission (92.6%). Length of hospitalization was 195.6±110.4 days, 22 were admitted to monitor their respiratory status and 46 were on MV on admission. Of these, 26 (38.2%) were admitted to attempt weaning from the respirator and 20 (29.4%) to enter a programme of permanent respiratory support. Weaning was successful in 23 out of 26 patients (88.4%), the process taking 47.2±49.3 days. Forty of them (58.8%) were discharged to their home. CONCLUSIONS: An IRCU can manage a substantial number of severe SCI patients who need MV, and an important number of them can be weaned from the respirator. It may also achieve a good success rate in the integration of MV-dependent patients within family and society.

Treatment of chronic ventilatory failure using a diaphragmatic pacemaker.

We present our series of patients with chronic ventilatory failure treated with electrophrenic respiration: 13 males and nine females with a mean age of 12 +/- 11.5 years. The etiology was, 13 tetraplegia, five sequelae of surgical treatment of intracranial lesions, and four central alveolar hypoventilation. The mean duration of the conditioning period were 3-4 months. Eighteen patients (81.8%) achieved permanent, diaphragmatically-paced breathing with bilateral stimulation and in four (18.2%) patients, pacing was only during sleep. Five patients died (22.7%): two during the hospital stay and three at home; two deaths had unknown cause and three were due respectively to, lack of at-home care, recurrence of an epidermoid tumor, and sequelae of accidental disconnection of the mechanical ventilation before beginning the conditioning period. Two cases were considered failures: One patient had transitory neurapraxia lasting 80 days, and the other had an ischemic spinal cord syndrome with progressive deterioration of the left-side response to stimulation. One patient had right phrenic nerve entrapment by scar tissue and four suffered infections. The follow-up periods since pacemaker implantation are currently: 1, 11 years; 4, 10 years, and 17, less than 5 years. The results of our experience demonstrate that complete stable ventilation can be achieved using diaphragmatic pacing and that it improves the prognosis and life quality of patients with severe chronic respiratory failure.

[Spinal cord sarcoidosis: diagnostic and therapeutic problems]. / Sarcoidosis de la médula espinal: problemas diagnósticos y terapéuticos.

Three cases of sarcoidosis with spinal cord involvement are reported. The diagnosis in each case was very difficult, being mistaken with tuberculosis in two of the patients and with paraneoplasic myelopathy in the other one. Initial treatment was incorrect for this reason. MRI without contrast was normal, but showed the existence of lesions in two cases after gadolinium administration. Symptoms improved in two patients with prednisone, but they got worse after tapering dose. Spinal sarcoidosis is very rare, but its diagnosis most be considered and MRI with gadolinium should be performed in subacute or chronic myelopathies. Treatment with prednisone should be prolonged.

[Acute nontraumatic myelopathies: a review of 36 cases]. / Mielopatías agudas no traumáticas: una revisión de 36 casos.

The objective of this investigation was to know the features of acute nontraumatic myelopathies in our area, given the paucity of reported data. Therefore, 36 episodes of myelitis observed during a 15-year period at Hospital Nacional de Parapléjicos were retrospectively reviewed. Cases associated with multiple sclerosis were excluded. On etiological basis these disorders were classified in vascular (in its turn subclassified in surgical and non-surgical) and inflammatory myelopathies. The functional prognosis was poor. Two patients with non-surgical vascular myelitis suffered a second episode of spinal ischemia which deteriorated their conditions. The usefulness of NMR seems to be limited.