An epidemiologic study of 5131 patients sustaining spinal cord injuries between 1973 and 1980 was conducted to determine and characterize the leading causes of death in this population. Patients who were studied had been admitted to one of seven federally designated regional spinal cord injury care systems and they survived for at least 24 hours after injury. When follow-up was terminated, 459 patients (9%) had died. Overall, the leading cause of death was pneumonia, followed by other subsequent unintentional injuries and suicides. The highest ratios of actual to expected deaths were for septicemia, pulmonary emboli, and pneumonia. Pneumonia was the leading cause of death among quadriplegics and persons at least 55 years of age, while among paraplegics and persons who were less than 55 years of age, subsequent unintentional injuries and suicides were the leading causes of death. While there is conclusive evidence that mortality rates for spinal-cord injured persons have declined dramatically since the end of World War II, many cause-specific mortality rates remain substantially above normal.

Cause of Death for Patients with Spinal Cord Injuries

Retrospective data analysis. To determine prevalence of orthostatic hypotension (OH) in patients with spinal cord injury (SCI) during the acute rehabilitation period. Quaternary care spinal unit, Vancouver General Hospital, British Columbia, Canada Eighty-nine patients with acute SCI stratified by neurological level (cervical, 55 (62%); upper thoracic, 12 (13%); lower thoracic, 22 (25%)), and graded by American Spinal Injury Association standards. Non-invasive measurement of systolic and diastolic blood pressure and heart rate were made at baseline and 3 min following an orthostatic challenge test administered during the first month after SCI. Patients with cervical or upper thoracic motor complete SCI more frequently experienced OH (P<0.01). OH persisted during the first month following SCI in 74% of cervical and only 20% of upper thoracic motor complete SCI patients. Patients with cervical and upper thoracic motor complete SCI are more likely to experience persistent OH than those with lower level or motor incomplete SCI during the first month of rehabilitation.

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Orthostatic hypotension in the first month following acute spinal cord injury

The prevalence of pulmonary embolism in chronically paralyzed subjects: a review of available evidence

/pdf/the-prevalence-of-pulmonary-embolism-in-chronically-4tpxmpbnnt.pdf

The prevalence of pulmonary embolism in chronically paralyzed subjects: a review of available evidence.

https://www.archives-pmr.org/article/S0003-9993(09)00206-8/pdf

Right Bundle Branch Block as a Screening Test for Pulmonary Embolism in Chronic Spinal Cord Injury

Las complicaciones respiratorias son la principal causa de muerte en los pacientes con tetraplejia, tanto en el periodo agudo como cronico. En esta categoria se incluyen diversas alteraciones como neumonias recurrentes, atelectasias, mal manejo de las secreciones, insuficiencia respiratoria e hipoventilacion. Ademas, son frecuentes patologias mas complejas como el tromboembolismo pulmonar y la apnea obstructiva del sueno. Se postula que las causas principales de los problemas respiratorios son la debilidad de los musculos intercostales y abdominales, y la disfuncion parcial o total del diafragma. Hoy en dia existen multiples alternativas terapeuticas para prevenir, manejar y tratar en forma especifica las diversas complicaciones. El proposito de este articulo es revisar las opciones terapeuticas actualmente vigentes y despertar el interes entre los clinicos para profundizar mas en este importante tema

/pdf/complicaciones-respiratorias-de-la-tetraplejia-una-mirada-a-2bn1br3asi.pdf

Complicaciones respiratorias de la tetraplejia: Una mirada a las alternativas terapéuticas actuales

Case report. To describe an unusual case of progressive pulmonary hypertension due to recurrent pulmonary embolism in a chronically paralyzed spinal cord injury patient. Veterans Administration Hospital, West Roxbury, MA, USA. A 57-year-old man, tetraplegic, sensory incomplete and motor complete for 30 years due to a diving accident, complained of lightheadedness and shortness of breath intermittently for 7 years. Examination during the latest episode revealed anxiety, confusion, respirations 28 per min, blood pressure 80/60 mmHg, and arterial pH 7.41, 28 mmHg, 95 mmHg on 2 l of oxygen. A chest film 2 weeks earlier had revealed a right-sided cutoff of pulmonary vasculature; the current film showed right-sided pleural effusion. Review of EKGs showed a trend of increasing right axis deviation with recovery and recurrences during the previous 9 years and a current incomplete right bundle branch block with clockwise rotation and inverted T waves in V1–4. Computerized tomography with contrast material revealed small pulmonary emboli, but only in retrospect. The patient died shortly after scanning. The pulmonary arteries were free of thromboemboli on gross examination but medium and small-sized arteries were constricted or obliterated with thrombotic material microscopically. The estimated ages of the thromboemboli ranged from days to years. The right ventricle was hypertrophied; the coronary arteries were patent. Recurrent pulmonary emboli resulted in chronic pulmonary hypertension and eventual death in a patient with chronic tetraplegia.

/pdf/recurrent-pulmonary-embolism-and-pulmonary-hypertension-in-3ao82oiv58.pdf

J A Hayes

Papers

Recurrent pulmonary embolism and pulmonary hypertension in chronic tetraplegia.