Definitive establishment of airway control is critical for optimal outcome in lower cervical XXXX .

@entity1 @entity131 @entity4619 @entity358 @entity1576 @entity1566 @entity130
BACKGROUND: Respiratory complications can undermine outcome from low cervical @entity1566 ( @entity1566 ) (C5-T1). Most devastating of these is catastrophic loss of airway control. This study sought to determine the incidence and effect of catastrophic airway loss ( @entity4619 ) and to define the need for elective intubation with subsequent tracheostomy to prevent potentially fatal outcomes. METHODS: A database of 54,838 consecutive @entity1 treated in a level I @entity130 center between January 1988 and December 2004 was queried to identify @entity1 with low cervical @entity1566 , without @entity131 . @entity1 were then stratified into complete or incomplete @entity1566 groups, based on clinical assessment of their @entity1566 . Mortality, age, injury severity, need for intubation, and tracheostomy were analyzed for each group using Fisher's exact test or Student's t test, as appropriate, accepting p < 0.05 as significant. RESULTS: One hundred eighty-six @entity1 met inclusion criteria. The majority of low cervical @entity1566 were complete (58%). Overall, 127 (68%) @entity1 required intubation, 88 (69%) required tracheostomy, and 27 died (15% of study population). Between each group there were significant differences in age and Injury Severity Score, however, within each group there were no significant differences in either. Eleven CSCI @entity1 were not intubated; four of whom were at family request. Six of the remaining seven @entity1 encountered fatal catastrophic airway loss. One @entity1 was discharged to rehabilitation. @entity1 with incomplete @entity1566 required intubation less frequently (38%); however, 50% of those required tracheostomy for intractable @entity358 . CONCLUSIONS: These data indicate that regardless of severity of low cervical @entity1566 , immediate, thorough evaluation for @entity1576 is necessary. Early intubation is mandatory for CSCI @entity1 . For incomplete @entity1 evidence of @entity1576 should prompt immediate airway intervention, half of whom will require tracheostomy.
