Spinal Travmalı Hastalarda Yoğun Bakım Takibi
Özet
Omurga ve omurilik travmaları ki bundan sonra spinal travma olarak ifade edilecektir, yüksek mortalite ve morbiditeye sebep olabilen ciddi bir halk sağlığı sorunudur. Travmanın oluşturduğu primer yaralanma dışında sekonder yaralanma mekanizmaları bu yüksek morbitenin en önemli sebeplerindendir. Bu nedenle bu hastalarda acil servis gelişinden cerrahi zamanlamaya, postoperatif yoğun bakım takip ve tedavisine uzanan dinamik, multidisipliner bir hasta yönetim mekanizmasına gerek vardır. Yaralanma genellikle yüksek enerjili travmalar sonucu omurga kemik ve/veya ligamentlerinde hasarlanma, omurilik ve kök basısına gelişebilmektedir. Spinal travma sonrası farklı derecelerde nörolojik defisitler gelişebilir. Bu defisitlerin bir kısmı geri dönüşümlü olup yakın yoğun bakım takip ve tedavisi ile mortalite ve morbidite azaltılabilmektedir. Bu bölümde spinal travmalı hastalara doğru tanı koymak, çeşitli sınıflandırma sistemleri ile algoritma belirlemek ve uygun tedaviyi uygulamak için gerekli bilgiler sunulmuş olup, yoğun bakım takibinde gelişebilecek komplikasyonlar ve komplikasyonların yönetimi konusunda bilgilendirmeyi amaçlamaktadır.
Referanslar
Singh A, Tetreault L, Kalsi-Ryan S, Nouri A, Fehlings MG. Global prevalence and incidence of traumatic spinal cord injury. Clin Epidemiol. 2014;6:309-31.
Russo GS, Mangan JJ, Galetta MS, Boody B, Bronson W, Segar A, et al. Update on Spinal Cord Injury Management. Clin Spine Surg. 2020;33(7):258-64.
Evans LT, Lollis SS, Ball PA. Management of acute spinal cord injury in the neurocritical care unit. Neurosurg Clin N Am. 2013;24(3):339-47.
Jia X, Kowalski RG, Sciubba DM, Geocadin RG. Critical care of traumatic spinal cord injury. J Intensive Care Med. 2013;28(1):12-23.
EKİCİ İ, TEMİZ C. Travmatik Omurilik Yaralanmaları Epidemiyolojisi, Değerlendirmesi ve Yönetimi. Türk Nöroşirürji Dergsi. 2020;30(3):458-65.
Ahuja CS, Wilson JR, Nori S, Kotter MRN, Druschel C, Curt A, et al. Traumatic spinal cord injury. Nature Reviews Disease Primers. 2017;3(1):17018.
Kurtzke JF. Epidemiology of spinal cord injury. Exp Neurol. 1975;48(3 pt. 2):163-236.
Yue JK, Winkler EA, Rick JW, Deng H, Partow CP, Upadhyayula PS, et al. Update on critical care for acute spinal cord injury in the setting of polytrauma. Neurosurg Focus. 2017;43(5):E19.
Malçok ÜA, Akar A. OMURGA VE OMURİLİK YARALANMALARINDA EPİDEMİYOLOJİ.
Allen BL, Jr., Ferguson RL, Lehmann TR, O'Brien RP. A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine. Spine (Phila Pa 1976). 1982;7(1):1-27.
Maton A, Bakalian H. Human biology and health. (No Title). 1993.
Brzuszkiewicz-Kuźmicka G, Szczegielniak J, Bączkowicz D. Age-related changes in shock absorption capacity of the human spinal column. Clin Interv Aging. 2018;13:987-93.
Rexed B. A cytoarchitectonic atlas of the spinal coed in the cat. Journal of Comparative Neurology. 1954;100(2):297-379.
Cramer GD, Darby SA. Clinical anatomy of the spine. Spinal Cord, and ANS. 2014.
Devivo MJ. Epidemiology of traumatic spinal cord injury: trends and future implications. Spinal Cord. 2012;50(5):365-72.
Hasler RM, Exadaktylos AK, Bouamra O, Benneker LM, Clancy M, Sieber R, et al. Epidemiology and predictors of cervical spine injury in adult major trauma patients: a multicenter cohort study. J Trauma Acute Care Surg. 2012;72(4):975-81.
Calancie B, Molano MR, Broton JG. Tendon reflexes for predicting movement recovery after acute spinal cord injury in humans. Clinical Neurophysiology. 2004;115(10):2350-63.
Stauffer ES. Diagnosis and prognosis of acute cervical spinal cord injury. Clinical orthopaedics and related research. 1975(112):9-15.
Jha A. ASIA Impairment Scale. In: Kreutzer JS, DeLuca J, Caplan B, editors. Encyclopedia of Clinical Neuropsychology. New York, NY: Springer New York; 2011. p. 255-7.
Aarabi B, Walters BC, Dhall SS, Gelb DE, Hurlbert RJ, Rozzelle CJ, et al. Subaxial Cervical Spine Injury Classification Systems. Neurosurgery. 2013;72.
Tong Y, Wu Q. Thoracolumbar Injury Classification and Severity Score. Journal of Neurosurgery: Spine. 2015;22(4):444-6.
Waters RL, Adkins RH, Yakura JS. Definition of complete spinal cord injury. Spinal Cord. 1991;29(9):573-81.
Dietz V, Grillner S, Trepp A, Hubli M, Bolliger M. Changes in spinal reflex and locomotor activity after a complete spinal cord injury: a common mechanism? Brain. 2009;132(8):2196-205.
Nowak DD, Lee JK, Gelb DE, Poelstra KA, Ludwig SC. Central cord syndrome. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2009;17(12):756-65.
Koehler PJ, Endtz LJ. The Brown-Séquard syndrome: true or false? Archives of neurology. 1986;43(9):921-4.
Fichman M, Piedra Buena IT. Rhinoplasty. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2023, StatPearls Publishing LLC.; 2023.
McKinley W, Hills A, Sima A. Posterior cord syndrome: Demographics and rehabilitation outcomes. The Journal of Spinal Cord Medicine. 2021;44(2):241-6.
Ko H-Y, Ko H-Y. Incomplete spinal cord injuries. Management and Rehabilitation of Spinal Cord Injuries. 2019:149-57.
Ham W, Schoonhoven L, Schuurmans MJ, Leenen LP. Pressure ulcers from spinal immobilization in trauma patients: a systematic review. Journal of Trauma and Acute Care Surgery. 2014;76(4):1131-41.
Bracken MB, Shepard MJ, Collins WF, Holford TR, Young W, Baskin DS, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med. 1990;322(20):1405-11.
Bracken MB, Shepard MJ, Holford TR, Leo-Summers L, Aldrich EF, Fazl M, et al. Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study. Jama. 1997;277(20):1597-604.
Knudson MM, Morabito D, Paiement GD, Shackleford S. Use of Low Molecular Weight Heparin in Preventing Thromboembolism in Trauma Patients. Journal of Trauma and Acute Care Surgery. 1996;41(3).
Fehlings MG, Wilson JR. Timing of Surgical Intervention in Spinal Trauma: What Does the Evidence Indicate? Spine. 2010;35(21S).
Sandean D. Management of acute spinal cord injury: A summary of the evidence pertaining to the acute management, operative and non-operative management. World J Orthop. 2020;11(12):573-83.
Taghavi S, Nassar Ak, Askari R. Hypovolemic Shock: StatPearls Publishing, Treasure Island (FL); 2022 2022.
Kelley DM. Hypovolemic Shock: An Overview. Critical Care Nursing Quarterly. 2005;28(1).
Zusman BE, Dixon CE, Jha RM, Vagni VA, Henchir JJ, Carlson SW, et al. Choice of Whole Blood versus Lactated Ringer's Resuscitation Modifies the Relationship between Blood Pressure Target and Functional Outcome after Traumatic Brain Injury plus Hemorrhagic Shock in Mice. J Neurotrauma. 2021;38(20):2907-17.
Holcomb JB, Tilley BC, Baraniuk S, Fox EE, Wade CE, Podbielski JM, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA. 2015;313(5):471-82.
Thompson K, Venkatesh B, Finfer S. Sepsis and septic shock: current approaches to management. Internal Medicine Journal. 2019;49(2):160-70.
Howell MD, Davis AM. Management of Sepsis and Septic Shock. JAMA. 2017;317(8):847-8.
Li P-F, Wang Y-L, Fang Y-L, Nan L, Zhou J, Zhang D. Effect of early enteral nutrition on outcomes of trauma patients requiring intensive care. Chinese Journal of Traumatology. 2020;23(03):163-7.
Mathus-Vliegen EMH. Clinical Observations: Nutritional Status, Nutrition, and Pressure Ulcers. Nutrition in Clinical Practice. 2001;16(5):286-91.
Roquilly A, Seguin P, Mimoz O, Feuillet F, Rosenczweig E, Chevalier F, et al. Risk factors for prolonged duration of mechanical ventilation in acute traumatic tetraplegic patients—a retrospective cohort study. Journal of Critical Care. 2014;29(2):313.e7-.e13.
Byrne D, Salzberg C. Major risk factors for pressure ulcers in the spinal cord disabled: a literature review. Spinal cord. 1996;34(5):255-63.
Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Physical therapy. 1987;67(2):206-7.
Referanslar
Singh A, Tetreault L, Kalsi-Ryan S, Nouri A, Fehlings MG. Global prevalence and incidence of traumatic spinal cord injury. Clin Epidemiol. 2014;6:309-31.
Russo GS, Mangan JJ, Galetta MS, Boody B, Bronson W, Segar A, et al. Update on Spinal Cord Injury Management. Clin Spine Surg. 2020;33(7):258-64.
Evans LT, Lollis SS, Ball PA. Management of acute spinal cord injury in the neurocritical care unit. Neurosurg Clin N Am. 2013;24(3):339-47.
Jia X, Kowalski RG, Sciubba DM, Geocadin RG. Critical care of traumatic spinal cord injury. J Intensive Care Med. 2013;28(1):12-23.
EKİCİ İ, TEMİZ C. Travmatik Omurilik Yaralanmaları Epidemiyolojisi, Değerlendirmesi ve Yönetimi. Türk Nöroşirürji Dergsi. 2020;30(3):458-65.
Ahuja CS, Wilson JR, Nori S, Kotter MRN, Druschel C, Curt A, et al. Traumatic spinal cord injury. Nature Reviews Disease Primers. 2017;3(1):17018.
Kurtzke JF. Epidemiology of spinal cord injury. Exp Neurol. 1975;48(3 pt. 2):163-236.
Yue JK, Winkler EA, Rick JW, Deng H, Partow CP, Upadhyayula PS, et al. Update on critical care for acute spinal cord injury in the setting of polytrauma. Neurosurg Focus. 2017;43(5):E19.
Malçok ÜA, Akar A. OMURGA VE OMURİLİK YARALANMALARINDA EPİDEMİYOLOJİ.
Allen BL, Jr., Ferguson RL, Lehmann TR, O'Brien RP. A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine. Spine (Phila Pa 1976). 1982;7(1):1-27.
Maton A, Bakalian H. Human biology and health. (No Title). 1993.
Brzuszkiewicz-Kuźmicka G, Szczegielniak J, Bączkowicz D. Age-related changes in shock absorption capacity of the human spinal column. Clin Interv Aging. 2018;13:987-93.
Rexed B. A cytoarchitectonic atlas of the spinal coed in the cat. Journal of Comparative Neurology. 1954;100(2):297-379.
Cramer GD, Darby SA. Clinical anatomy of the spine. Spinal Cord, and ANS. 2014.
Devivo MJ. Epidemiology of traumatic spinal cord injury: trends and future implications. Spinal Cord. 2012;50(5):365-72.
Hasler RM, Exadaktylos AK, Bouamra O, Benneker LM, Clancy M, Sieber R, et al. Epidemiology and predictors of cervical spine injury in adult major trauma patients: a multicenter cohort study. J Trauma Acute Care Surg. 2012;72(4):975-81.
Calancie B, Molano MR, Broton JG. Tendon reflexes for predicting movement recovery after acute spinal cord injury in humans. Clinical Neurophysiology. 2004;115(10):2350-63.
Stauffer ES. Diagnosis and prognosis of acute cervical spinal cord injury. Clinical orthopaedics and related research. 1975(112):9-15.
Jha A. ASIA Impairment Scale. In: Kreutzer JS, DeLuca J, Caplan B, editors. Encyclopedia of Clinical Neuropsychology. New York, NY: Springer New York; 2011. p. 255-7.
Aarabi B, Walters BC, Dhall SS, Gelb DE, Hurlbert RJ, Rozzelle CJ, et al. Subaxial Cervical Spine Injury Classification Systems. Neurosurgery. 2013;72.
Tong Y, Wu Q. Thoracolumbar Injury Classification and Severity Score. Journal of Neurosurgery: Spine. 2015;22(4):444-6.
Waters RL, Adkins RH, Yakura JS. Definition of complete spinal cord injury. Spinal Cord. 1991;29(9):573-81.
Dietz V, Grillner S, Trepp A, Hubli M, Bolliger M. Changes in spinal reflex and locomotor activity after a complete spinal cord injury: a common mechanism? Brain. 2009;132(8):2196-205.
Nowak DD, Lee JK, Gelb DE, Poelstra KA, Ludwig SC. Central cord syndrome. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2009;17(12):756-65.
Koehler PJ, Endtz LJ. The Brown-Séquard syndrome: true or false? Archives of neurology. 1986;43(9):921-4.
Fichman M, Piedra Buena IT. Rhinoplasty. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2023, StatPearls Publishing LLC.; 2023.
McKinley W, Hills A, Sima A. Posterior cord syndrome: Demographics and rehabilitation outcomes. The Journal of Spinal Cord Medicine. 2021;44(2):241-6.
Ko H-Y, Ko H-Y. Incomplete spinal cord injuries. Management and Rehabilitation of Spinal Cord Injuries. 2019:149-57.
Ham W, Schoonhoven L, Schuurmans MJ, Leenen LP. Pressure ulcers from spinal immobilization in trauma patients: a systematic review. Journal of Trauma and Acute Care Surgery. 2014;76(4):1131-41.
Bracken MB, Shepard MJ, Collins WF, Holford TR, Young W, Baskin DS, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med. 1990;322(20):1405-11.
Bracken MB, Shepard MJ, Holford TR, Leo-Summers L, Aldrich EF, Fazl M, et al. Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study. Jama. 1997;277(20):1597-604.
Knudson MM, Morabito D, Paiement GD, Shackleford S. Use of Low Molecular Weight Heparin in Preventing Thromboembolism in Trauma Patients. Journal of Trauma and Acute Care Surgery. 1996;41(3).
Fehlings MG, Wilson JR. Timing of Surgical Intervention in Spinal Trauma: What Does the Evidence Indicate? Spine. 2010;35(21S).
Sandean D. Management of acute spinal cord injury: A summary of the evidence pertaining to the acute management, operative and non-operative management. World J Orthop. 2020;11(12):573-83.
Taghavi S, Nassar Ak, Askari R. Hypovolemic Shock: StatPearls Publishing, Treasure Island (FL); 2022 2022.
Kelley DM. Hypovolemic Shock: An Overview. Critical Care Nursing Quarterly. 2005;28(1).
Zusman BE, Dixon CE, Jha RM, Vagni VA, Henchir JJ, Carlson SW, et al. Choice of Whole Blood versus Lactated Ringer's Resuscitation Modifies the Relationship between Blood Pressure Target and Functional Outcome after Traumatic Brain Injury plus Hemorrhagic Shock in Mice. J Neurotrauma. 2021;38(20):2907-17.
Holcomb JB, Tilley BC, Baraniuk S, Fox EE, Wade CE, Podbielski JM, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA. 2015;313(5):471-82.
Thompson K, Venkatesh B, Finfer S. Sepsis and septic shock: current approaches to management. Internal Medicine Journal. 2019;49(2):160-70.
Howell MD, Davis AM. Management of Sepsis and Septic Shock. JAMA. 2017;317(8):847-8.
Li P-F, Wang Y-L, Fang Y-L, Nan L, Zhou J, Zhang D. Effect of early enteral nutrition on outcomes of trauma patients requiring intensive care. Chinese Journal of Traumatology. 2020;23(03):163-7.
Mathus-Vliegen EMH. Clinical Observations: Nutritional Status, Nutrition, and Pressure Ulcers. Nutrition in Clinical Practice. 2001;16(5):286-91.
Roquilly A, Seguin P, Mimoz O, Feuillet F, Rosenczweig E, Chevalier F, et al. Risk factors for prolonged duration of mechanical ventilation in acute traumatic tetraplegic patients—a retrospective cohort study. Journal of Critical Care. 2014;29(2):313.e7-.e13.
Byrne D, Salzberg C. Major risk factors for pressure ulcers in the spinal cord disabled: a literature review. Spinal cord. 1996;34(5):255-63.
Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Physical therapy. 1987;67(2):206-7.
