IDEALIZED CARE OF THE ACUTELY INJURED SPINAL CORD IN SWITZERLAND

Abstract

Case histories of 188 patients with acute traumatic tetraplegia who were admitted to the National Spinal Injuries Centre over the past 10 years are reviewed. Since the introduction, in 1968, of a highly specialized, nationwide helicopter rescue system and the immediate transfer of all patients with multiple trauma to an intensive-care unit attached to the Paraplegic Centre, the mortality rate for complete tetraplegics (n = 117) has dropped from 32.5% (1966) to 6.8% (1976), and for the 71 patients with incomplete lesions from 9.9% to 1.4%. Most early deaths were found to be related to pulmonary complications: paralysis of the thoracic muscles, severe hypoventilation, and absence of the cough reflex may lead to severe respiratory insufficiency within a few hours after injury even in the absence of any direct trauma to the chest. Tracheotomy had to be performed in 22.2% (n = 26) of our patients with complete and in 5.6% (n = 4) of those with incomplete lesions. In 33.5% of all tetraplegics temporary nasotracheal intubation for periods of up to 2 weeks proved entirely sufficient with no complications. Four patients with tracheotomy developed severe local infection with resistant Gram-negative germs, two showed posterior tracheomalacia, one had distal tracheal stenosis, and one required surgical care for acute local hemorrhage. In view of this relatively high rate of complications (26.7%), “prophylactic tracheotomy” does not seem advisable. Facilities for continuous monitoring of central venous pressure, arterial pressure, pulse rate, breathing pattern, pO2, pCO2, pH, electrolytes, and blood and urine osmolality must be available for all patients with neurologic injuries above C6.