Risk Factors for Postoperative Gastrointestinal Dysfunction After Percutaneous Dilatational Tracheostomy in Patients with Traumatic Cervical Spinal Cord Injury: A Single‑Center Retrospective Study
This single-center retrospective study of 89 patients with traumatic cervical spinal cord injury identifies neuromuscular blocker use and high-level cervical injury (C1–C4) as independent risk factors for postoperative gastrointestinal dysfunction, revealing that while high-level injury confers a substantial baseline risk, neuromuscular blockers significantly increase the incidence of dysfunction in patients with lower-level injuries, suggesting that routine neuromuscular blocker use should be avoided.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
When the spinal cord in the neck is severely damaged by trauma, the body's automatic control systems often go into chaos. One of the most critical systems to fail is the ability to breathe, forcing patients onto machines that push air into their lungs. To help these patients breathe comfortably over the long term, doctors often perform a procedure called a percutaneous dilatational tracheostomy. This involves making a small opening in the windpipe through the skin of the neck, a technique that is generally faster and less invasive than traditional open surgery. However, patients with these neck injuries face a hidden and common struggle: their digestive systems often shut down. The stomach stops emptying, the intestines slow to a crawl, and the belly swells with gas. This condition, known as gastrointestinal dysfunction, is not just uncomfortable; it can delay recovery and complicate care. For years, medical teams have debated whether using strong muscle-relaxing drugs during the neck procedure might make this digestive problem worse, or if the severity of the spinal injury itself is the true culprit.
A researcher at Ningbo Sixth Hospital set out to untangle this relationship by looking back at the medical records of eighty-nine patients who had suffered traumatic neck injuries and underwent this specific tracheostomy procedure between 2021 and 2026. They wanted to know two things: how often these patients developed digestive problems after the surgery, and whether the use of neuromuscular blockers—drugs that temporarily paralyze muscles to make the procedure easier—was a cause. They also wanted to see if the level of the spinal injury mattered, distinguishing between very high injuries near the top of the neck and lower injuries further down the spine. The researcher defined digestive dysfunction as significant swelling in the abdomen, a large amount of fluid left in the stomach after suctioning, or gas trapped in the intestinal walls, all occurring within a week of the procedure.
The study found that nearly one-third of the patients developed these digestive issues. When the researcher broke down the data, they discovered that the use of muscle-relaxing drugs was a major factor. Patients who received these drugs were significantly more likely to develop digestive dysfunction than those who did not. However, the story became more complex when the researcher looked at the specific level of the spinal injury. They found that patients with very high injuries, affecting the top four vertebrae of the neck, had a high rate of digestive problems regardless of whether they received the muscle-relaxing drugs or not. In this group, the dysfunction rate was fifty percent in both cases. It appeared that the injury itself had already disrupted the nervous system's control over the gut so severely that adding a muscle relaxant made little additional difference.
In contrast, the situation was very different for patients with lower neck injuries. In this group, those who did not receive muscle relaxants had a relatively low rate of digestive problems, around thirteen percent. But for those who did receive the drugs, the rate jumped to nearly forty-five percent. This meant that for patients with lower injuries, using the muscle relaxant more than tripled their risk of developing digestive complications. The researcher calculated that these two factors—the drug and the injury level—acted independently rather than working together to create a massive combined effect. The drug caused problems through a chemical mechanism that slowed muscle movement, while the high injury caused problems by disrupting the nerve signals that normally tell the gut to move.
Crucially, the study found no evidence that using these muscle relaxants helped the surgery go better. The time it took to perform the procedure, the success rate of placing the tube, and the occurrence of other complications like low blood pressure were exactly the same whether the drugs were used or not. This lack of benefit, combined with the clear increase in risk for digestive problems, led the researcher to conclude that routine use of these drugs during this specific surgery is not advisable. They suggest that for patients with lower injuries, the risk is particularly high and the benefit nonexistent. For patients with the highest injuries, the risk is already so high due to the injury itself that avoiding the drugs alone will not prevent the problem, and these patients need a broader strategy of care to manage their digestive health. The findings offer a clear path forward: doctors should carefully consider the level of spinal injury before deciding to use muscle relaxants, and in many cases, they should skip them entirely to spare patients from unnecessary complications.
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