Acute airway obstruction in cervical spinal procedures with bone morphogenetic proteins.
Summary of "Acute airway obstruction in cervical spinal procedures with bone morphogenetic proteins."
OBJECTIVES:
: Bone morphogenetic proteins (BMP) used in anterior cervical spinal procedures causes an inflammatory response resulting in upper-airway obstruction between postoperative days 2 to 7. The purpose of this study is to determine the incidence and severity of complications associated with use of BMP. STUDY
DESIGN:
: Retrospective cohort study.
METHODS:
: This is a retrospective study of 260 patients who underwent cervical spinal procedures with BMP from 2004 to 2009 and a control group of 515 patients who underwent cervical spinal procedures without BMP during the same period at a tertiary care institution. The two groups were compared on hospital length of stay (LOS), hospital charges, incidence of airway obstruction, unplanned intubations after surgery, tracheotomies, intensive care unit (ICU) admissions, hoarseness, dyspnea, respiratory failure, dysphasia, dysphagia, readmissions, and need for percutaneous endoscopic gastrostomy (PEG) tubes.
RESULTS:
: Patients who underwent cervical spine procedures with BMP were noted to have significantly longer hospital stays (P = .001) and higher hospital charges (P = .001) than the control group. Tracheotomies (P = .024), unplanned intubations after surgery (P = .003), dysphagia (P = .001), dyspnea (P = .001), respiratory failure (P = .001), hospital readmissions (P = .040), ICU admissions (P = .001), and 90-day mortality rates (P = .047) were increased for the BMP group.
CONCLUSIONS:
: The use of BMP in anterior cervical spinal procedures results in acute airway obstruction due to an extensive soft-tissue inflammatory reaction that is most likely to occur 2 to 7 days after surgery. The increased incidence of unplanned intubations and tracheotomies demonstrates the risk associated with BMP in cervical spinal procedures. Laryngoscope, 2010.
Affiliation
Department of Otolaryngology-Head and Neck Surgery, Detroit, Michigan.
Journal Details
This article was published in the following journal.
Name: The Laryngoscope
ISSN: 1531-4995
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20824786
- DOI: http://dx.doi.org/10.1002/lary.21096
Medical and Biotech [MESH] Definitions
Lung Diseases, Obstructive
Any disorder marked by obstruction of conducting airways of the lung. AIRWAY OBSTRUCTION may be acute, chronic, intermittent, or persistent.
Asthma
A form of bronchial disorder with three distinct components: airway hyper-responsiveness (RESPIRATORY HYPERSENSITIVITY), airway INFLAMMATION, and intermittent AIRWAY OBSTRUCTION. It is characterized by spasmodic contraction of airway smooth muscle, WHEEZING, and dyspnea (DYSPNEA, PAROXYSMAL).
Cervical Plexus
A network of nerve fibers originating in the upper four cervical spinal cord segments. The cervical plexus distributes cutaneous nerves to parts of the neck, shoulders, and back of the head, and motor fibers to muscles of the cervical spinal column, infrahyoid muscles, and the diaphragm.
Asthma, Exercise-induced
Asthma attacks following a period of exercise. Usually the induced attack is short-lived and regresses spontaneously. The magnitude of postexertional airway obstruction is strongly influenced by the environment in which exercise is performed (i.e. inhalation of cold air during physical exertion markedly augments the severity of the airway obstruction; conversely, warm humid air blunts or abolishes it).
Airway Management
Evaluation, planning, and use of a range of procedures and airway devices for the maintenance or restoration of a patient's ventilation.
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