Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Perceptions of critically ill individuals with acute and chronic spinal cord injury requiring a tracheostomy tube

Spinal Cord Series and Cases volume 10, Article number: 12 (2024) Cite this article

Subjects

Abstract

Study design

Observational study.

Objectives

To evaluate the perceptions of patients requiring a tracheostomy tube and to identify possible different perceptions in critically ill patients with tracheostomy tubes who have acute (ASCI) or chronic spinal cord injuries (CSCI).

Setting

Medical and surgical intensive care units (ICU) and intermediate care unit of the BG University Hospital Bergmannsheil Bochum, Germany.

Methods

Patients who met the inclusion criteria completed a 25-item questionnaire on two consecutive days regarding their experiences and perceptions in breathing, coughing, pain, speaking, swallowing, and comfort of the tracheostomy tube.

Results

A total of 51 persons with ASCI (n = 31) and CSCI (n = 20) were included with a mean age of 53 years. Individuals with ASCI reported significantly more frequent pain and swallowing problems as compared to individuals with CSCI (p ≤ 0.014) at initial assessment. There were no differences between ASCI and CSCI reported with respect to speaking and overall comfort.

Conclusions

It is necessary to regularly assess the perceptions of critically ill patients with tracheostomy tubes with ASCI or CSCI in the daily ICU care routine. We were able to assess these perceptions in different categories. For the future, evaluating the perception of individuals with SCI and a tracheostomy should be implemented to their daily routine care.

Trial registration

DRKS00022073.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1

Similar content being viewed by others

Data availability

Data that was generated and analyzed during this study can be found within the published article. Additional data are available from the corresponding author on reasonable request.

References

  1. Berlowitz DJ, Wadsworth B, Ross J. Respiratory problems and management in people with spinal cord injury. Breathe. 2016;12:328–40. https://doi.org/10.1183/20734735.012616.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Rogers WK, Todd M. Acute spinal cord injury. Best Pract Res Clin Anaesthesiol. 2016;30:27–39. https://doi.org/10.1016/j.bpa.2015.11.003.

    Article  PubMed  Google Scholar 

  3. Leelapattana P, Fleming JC, Gurr KR, Bailey SI, Parry N, Bailey CS. Predicting the need for tracheostomy in patients with cervical spinal cord injury. J Trauma Acute Care Surg. 2012;73:880–4. https://doi.org/10.1097/TA.0b013e318251fb34.

    Article  PubMed  Google Scholar 

  4. Branco BC, Plurad D, Green DJ, Inaba K, Lam L, Cestero R, et al. Incidence and clinical predictors for tracheostomy after cervical spinal cord injury: a National Trauma Databank review. J Trauma. 2011;70:111–5. https://doi.org/10.1097/TA.0b013e3181d9a559.

    Article  PubMed  Google Scholar 

  5. Kupfer M, Kucer BT, Kupfer H, Formal CS. Persons with chronic spinal cord injuries in the emergency department: a review of a unique population. J Emerg Med. 2018;55:206–12. https://doi.org/10.1016/j.jemermed.2018.04.029.

    Article  PubMed  Google Scholar 

  6. Ong B, Wilson JR, Henzel MK. Management of the patient with chronic spinal cord injury. Med Clin North Am. 2020;104:263–78. https://doi.org/10.1016/j.mcna.2019.10.006.

    Article  PubMed  Google Scholar 

  7. Berney S, Bragge P, Granger C, Opdam H, Denehy L. The acute respiratory management of cervical spinal cord injury in the first 6 weeks after injury: a systematic review. Spinal Cord. 2011;49:17–29. https://doi.org/10.1038/sc.2010.39.

    Article  CAS  PubMed  Google Scholar 

  8. Yugue I, Okada S, Ueta T, Maeda T, Mori E, Kawano O, et al. Analysis of the risk factors for tracheostomy in traumatic cervical spinal cord injury. Spine. 2012;37:E1633–8. https://doi.org/10.1097/BRS.0b013e31827417f1.

    Article  PubMed  Google Scholar 

  9. Childs BR, Moore TA, Como JJ, Vallier HA. American Spinal Injury Association Impairment Scale predicts the need for tracheostomy after cervical spinal cord injury. Spine. 2015;40:1407–13. https://doi.org/10.1097/BRS.0000000000001008.

    Article  PubMed  Google Scholar 

  10. Schonhofer B, Geiseler J, Dellweg D, Fuchs H, Moerer O, Weber-Carstens S, et al. Prolonged weaning: S2k guideline published by the German Respiratory Society. Respiration. 2020:1–102. https://doi.org/10.1159/000510085.

  11. Newman H, Clunie G, Wallace S, Smith C, Martin D, Pattison N. What matters most to adults with a tracheostomy in ICU and the implications for clinical practice: a qualitative systematic review and metasynthesis. J Crit Care. 2022;72:154145 https://doi.org/10.1016/j.jcrc.2022.154145.

    Article  PubMed  Google Scholar 

  12. Sun GH, Chen SW, MacEachern MP, Wang J. Successful decannulation of patients with traumatic spinal cord injury: a scoping review. J Spinal Cord Med. 2022;45:498–509. https://doi.org/10.1080/10790268.2020.1832397.

    Article  CAS  PubMed  Google Scholar 

  13. Scantling D, Granche J, Williamson J, Gracely E, Thosani D, McCracken B. Development of clinical tracheostomy score to identify cervical spinal cord injury patients requiring prolonged ventilator support. J Trauma Acute Care Surg. 2019;87:195–9. https://doi.org/10.1097/TA.0000000000002286.

    Article  PubMed  Google Scholar 

  14. Raimondi N, Vial MR, Calleja J, Quintero A, Cortes A, Celis E, et al. Evidence-based guidelines for the use of tracheostomy in critically ill patients. J Crit Care. 2017;38:304–18. https://doi.org/10.1016/j.jcrc.2016.10.009.

    Article  PubMed  Google Scholar 

  15. McRae J, Smith C, Beeke S, Emmanuel A. Members of the Delphi expert panel g. Development of a swallowing risk screening tool and best practice recommendations for the management of oropharyngeal dysphagia following acute cervical spinal cord injury: an international multi-professional Delphi consensus. Disabil Rehabil. 2021:1–14. https://doi.org/10.1080/09638288.2021.2012607.

  16. Hirota R, Terashima Y, Ohnishi H, Yamashita T, Yokogawa N, Sasagawa T, et al. Prognostic factors for respiratory dysfunction for cervical spinal cord injury and/or cervical fractures in elderly patients: a multicenter survey. Global Spine J. 2022:21925682221095470. https://doi.org/10.1177/21925682221095470.

  17. Vandenbroucke JP, von Elm E, Altman DG, Gotzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Epidemiology. 2007;18:805–35. https://doi.org/10.1097/EDE.0b013e3181577511.

    Article  PubMed  Google Scholar 

  18. Ely EW, Truman B, Shintani A, Thomason JW, Wheeler AP, Gordon S, et al. Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA. 2003;289:2983–91. https://doi.org/10.1001/jama.289.22.2983.

    Article  PubMed  Google Scholar 

  19. Gaudreau JD, Gagnon P, Harel F, Tremblay A, Roy MA. Fast, systematic, and continuous delirium assessment in hospitalized patients: the nursing delirium screening scale. J Pain Symptom Manage. 2005;29:368–75. https://doi.org/10.1016/j.jpainsymman.2004.07.009.

    Article  PubMed  Google Scholar 

  20. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83. https://doi.org/10.1016/0021-9681(87)90171-8.

    Article  CAS  PubMed  Google Scholar 

  21. Fawcett JW, Curt A, Steeves JD, Coleman WP, Tuszynski MH, Lammertse D, et al. Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP panel: spontaneous recovery after spinal cord injury and statistical power needed for therapeutic clinical trials. Spinal Cord. 2007;45:190–205. https://doi.org/10.1038/sj.sc.3102007.

    Article  CAS  PubMed  Google Scholar 

  22. Burns AS, Marino RJ, Flanders AE, Flett H. Clinical diagnosis and prognosis following spinal cord injury. Handb Clin Neurol. 2012;109:47–62. https://doi.org/10.1016/B978-0-444-52137-8.00003-6.

    Article  PubMed  Google Scholar 

  23. Maynard FM Jr., Bracken MB, Creasey G, Ditunno JF Jr., Donovan WH, Ducker TB, et al. International standards for neurological and functional classification of spinal cord injury. American Spinal Injury Association. Spinal Cord. 1997;35:266–74. https://doi.org/10.1038/sj.sc.3100432.

    Article  PubMed  Google Scholar 

  24. Ull C, Weckwerth C, Hamsen U, Jansen O, Spieckermann A, Schildhauer TA, et al. Development of the tracheostomy well-being score in critically ill patients. Eur J Trauma Emerg Surg. 2022. https://doi.org/10.1007/s00068-022-02120-9.

  25. Ull C, Hamsen U, Weckwerth C, Schildhauer TA, Gaschler R, Jansen O, et al. The use of predefined scales and scores with eye-tracking devices for symptom identification in critically ill nonverbal patients. J Trauma Acute Care Surg. 2022;92:640–7. https://doi.org/10.1097/TA.0000000000003494.

    Article  CAS  PubMed  Google Scholar 

  26. Nakarada-Kordic I, Patterson N, Wrapson J, Reay SD. A systematic review of patient and caregiver experiences with a tracheostomy. Patient. 2018;11:175–91. https://doi.org/10.1007/s40271-017-0277-1.

    Article  PubMed  Google Scholar 

  27. Breckenridge SJ, Chlan L, Savik K. Impact of tracheostomy placement on anxiety in mechanically ventilated adult ICU patients. Heart Lung. 2014;43:392–8. https://doi.org/10.1016/j.hrtlng.2014.01.005.

    Article  PubMed  PubMed Central  Google Scholar 

  28. van Diemen T, van Leeuwen C, van Nes I, Geertzen J, Post M. Body image in patients with spinal cord injury during inpatient rehabilitation. Arch Phys Med Rehabil. 2017;98:1126–31. https://doi.org/10.1016/j.apmr.2016.10.015.

    Article  PubMed  Google Scholar 

  29. Cuff L, Fann JR, Bombardier CH, Graves DE, Kalpakjian CZ. Depression, pain intensity, and interference in acute spinal cord injury. Top Spinal Cord Inj Rehabil. 2014;20:32–9. https://doi.org/10.1310/sci2001-32.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Hoffman JM, Bombardier CH, Graves DE, Kalpakjian CZ, Krause JS. A longitudinal study of depression from 1 to 5 years after spinal cord injury. Arch Phys Med Rehabil. 2011;92:411–8. https://doi.org/10.1016/j.apmr.2010.10.036.

    Article  PubMed  Google Scholar 

  31. Craig A, Tran Y. Psychological aspects associated with spinal cord injury rehabilitation: new directions and best evidence. Nova Science Publishers, 2008. 286 p.

Download references

Acknowledgements

We thank Monica Monica Mary Heil for language editing the manuscript. This work was supported by the ”Junior Clinician Scientist Program” of the Ruhr-University Bochum, Germany [grant number K129-19]. The funding bodies did not influence the study’s design, the collection, analysis, and interpretation of data, nor in writing the manuscript.

Author information

Authors and Affiliations

  1. Faculty of Psychology, FernUniversität of Hagen, Universitätsstraße 47, 58097, Hagen, Germany

    Christina Weckwerth & Robert Gaschler

  2. Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany

    Christian Waydhas, Uwe Hamsen, Oliver Cruciger, Aileen Spieckermann, Thomas Armin Schildhauer & Christopher Ull

  3. Department of Trauma Surgery, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany

    Christian Waydhas

  4. Department of Spinal Cord Injuries, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany

    Mirko Aach

Authors
  1. Christina Weckwerth
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christian Waydhas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Uwe Hamsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Oliver Cruciger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Aileen Spieckermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Thomas Armin Schildhauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mirko Aach
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Robert Gaschler
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Christopher Ull
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Concept/design: CWe, CWa, RG, CU; Data analysis/interpretation: CWe, CWa, RG, CU; Writing of article: CWe, AS, CU; Critical revision of the article: CWe, CWa, UH, OC, AS, TAS, RG, MA, CU; Approval of article: CWe, CWa, UH, OC, AS, TAS, RG, MA, CU; Funding secured by: CU; Data collection: CU.

Corresponding author

Correspondence to Christopher Ull.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. It was approved by the local ethics committee (Ruhr-University Bochum, Germany, grant number of approval 18-6620-BR). Informed consent was obtained from each person. We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during this research.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Weckwerth, C., Waydhas, C., Hamsen, U. et al. Perceptions of critically ill individuals with acute and chronic spinal cord injury requiring a tracheostomy tube. Spinal Cord Ser Cases 10, 12 (2024). https://doi.org/10.1038/s41394-024-00624-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41394-024-00624-7

Search

Advanced search

Quick links