Management of patients with post-traumatic quadriplegia during the acute phase

Abstract

The early management of cervical spinal cord injury is critical. This involves therapies of motor, sensitive and autonomic consequences of the cervical spinal injury to limit the extension of secondary lesions. The initial neurological assessment is based on the ASIA score (American Spinal Injury Association score) and CT-scan or MR imaging. Hemodynamic management requires a careful use of vascular filling and vasopressors in these patients where cardiac adaptive systems may be altered. Respiratory management involves assessment of the respiratory function, and, whenever possible, early tracheal extubation, active physiotherapy and non-invasive ventilation. This strategy may reduce the requirement for tracheostomy and the duration of mechanical ventilation. Prevention and treatment of other complications related to the immobilization should be considered.