The Interface Between the Level of the Damage and the Respiratory Tract Infection in Patients After Traumatic Cervical Spinal Cord Injury.

Aim: to find out whether the level of the cervical spinal cord injury affects the onset of respiratory tract infection and evaluate the prevailing pathogens. Objectives: to assess the relationship between the level of cervical spinal cord injury and the time of extubation and tracheostomy, the duration of the mechanical ventilation and the age of the respiratory tract infection. To determine whether the duration of mechanical ventilation correlates with the respiratory infection. To identify the most frequent microorganisms of hospital infection. Methods: 33 medical history cases of patients after cervical spinal cord injury (2013 – 2016 years) were analyzed. Data included: the damaged spinal cord segment, class of ASIA, the time of intubation, extubation and tracheostomy, mechanical ventilation needed, the occurrence of infection, co-morbidity, the duration of the patient's ICU treatment and its outcome. Patients were divided into 2 groups according to the height of the injury: high (C1-4) and low (C5-7). The age of patients (1st group under 40, 2nd – 40 – 59, 3rd – 60 and more), gender, concomitant diseases and other mentioned facts probably influenced the appearance of pneumonia and patient outcomes were analyzed. Results: the extubation was performed in the C1-4 group in 2.86 ± 1.86 days and tracheostomy to 7.86 ± 5.61, and in the C5-7 group, respectively – 1.92 ± 0.51 and 6.14 ± 3.8 days, (p>0.05). The average duration of mechanical ventilation in the C1-4 group is 11.85 ± 14.13 days, in the C5-7 group – 11.6 ± 18.12 days, (p>0,05). In patients with mechanical ventilation over than 5 days, respiratory infection was found 92.9 proc., (p0,05). The frequency of hospital infections is 78.95 proc. 19.5 proc. Klebsiella spp., 17.4 proc. S. aureus, 10.9 proc. P. aeruginosa and 10.9 proc. Streptococcus spp., (p>0,05). Conclusions: the extubation and tracheostomy performance time in groups is not statistically significant difference. The duration of the mechanical ventilation in groups is not statistically significant difference. The occurrence of respiratory infection is directly proportional to the duration of the mechanical ventilation. In the C1-4 group pneumonia was observed in shorter time after injury and it is statistically significant. There is no statistically significant difference between age and respiratory tract infection. The frequency of hospital infections is 78.95 proc. The main causative agents are Klebsiella spp., S. aureus, P. aeruginosa and Streptococcus spp