{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T04:17:08Z","timestamp":1777868228767,"version":"3.51.4"},"reference-count":80,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurology International"],"abstract":"<jats:p>Traumatic spinal cord injury (TSCI) frequently necessitates prolonged ventilatory support, raising the clinical dilemma of early versus late tracheostomy. Despite decades of debate, no randomized controlled trials (RCTs) have been conducted exclusively in TSCI populations, and evidence remains largely observational. This review synthesizes contemporary evidence on the timing and outcomes of tracheostomy in acute TSCI. Across multiple cohort studies and meta-analyses, early tracheostomy (\u22647 days) is consistently associated with shorter mechanical ventilation duration, shorter ICU length of stay, reduced sedation exposure, and fewer immobility-related complications. Data suggested a lower incidence of ventilator-associated pneumonia, though mortality outcomes remain unchanged. Importantly, cervical-level injuries appear to derive the most significant benefit, while variability in defining \u201cearly\u201d versus \u201clate\u201d complicates direct comparisons. Despite methodological limitations, including reliance on retrospective data, inconsistent definitions, and lack of long-term follow-up, cumulative evidence indicates that early tracheostomy improves short-term outcomes. The optimal timing of tracheostomy in TSCI remains uncertain. Current observational evidence suggests that early tracheostomy in cervical SCI is associated with a reduction in the duration of mechanical ventilation, ICU stay, and respiratory complications. These benefits might come from better access to the airways, less anatomical dead space, better clearance of secretions, less need for sedation, together with earlier mobilization and rehabilitation. Mortality outcomes remain inconclusive. In the absence of randomized trials and long-term data, individualized decisions based on injury level, clinical course, and institutional expertise are essential.<\/jats:p>","DOI":"10.3390\/neurolint18050085","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T10:47:28Z","timestamp":1777546048000},"page":"85","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Versus Late Tracheostomy in Traumatic Spinal Injury: A Narrative Review"],"prefix":"10.3390","volume":"18","author":[{"given":"Saeed","family":"Mahmood","sequence":"first","affiliation":[{"name":"Department of Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9947-8730","authenticated-orcid":false,"given":"Mohammad","family":"Asim","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2584-953X","authenticated-orcid":false,"given":"Ayman","family":"El-Menyar","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar"},{"name":"Department of Clinical Medicine, Weill Cornell Medical School, Doha 24144, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8250-7355","authenticated-orcid":false,"given":"Sandro","family":"Rizoli","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hassan","family":"Al-Thani","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"615","DOI":"10.31616\/asj.2023.0094","article-title":"Ventilatory Strategies in Traumatic Cervical Spinal Cord Injury: Controversies and Current Updates","volume":"17","author":"Kumar","year":"2023","journal-title":"Asian Spine J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1183\/20734735.012616","article-title":"Respiratory problems and management in people with spinal cord injury","volume":"12","author":"Berlowitz","year":"2016","journal-title":"Breathe"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Wulf, M.J., and Tom, V.J. (2023). Consequences of spinal cord injury on the sympathetic nervous system. Front. Cell. Neurosci., 17.","DOI":"10.3389\/fncel.2023.999253"},{"key":"ref_4","first-page":"151","article-title":"Tracheostomy in spinal cord injured patients","volume":"1","author":"Ganuza","year":"2011","journal-title":"Transl. Med. UniSa."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/j.amjsurg.2014.07.016","article-title":"Predictors of the necessity for early tracheostomy in patients with acute cervical spinal cord injury: A 15-year experience","volume":"209","author":"Jones","year":"2015","journal-title":"Am. J. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Hendershot, K.A., and O\u2019Phelan, K.H. (2022). Respiratory Complications and Weaning Considerations for Patients with Spinal Cord Injuries: A Narrative Review. J. Pers. Med., 13.","DOI":"10.3390\/jpm13010097"},{"key":"ref_7","first-page":"956","article-title":"Efficacy and Safety of Early Tracheotomy in Acute Cervical Spinal Cord Injury","volume":"30","author":"Wang","year":"2020","journal-title":"J. Coll. Physicians Surg. Pak."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e000651","DOI":"10.1136\/bmjresp-2020-000651","article-title":"Management of tracheostomies in the intensive care unit: A scoping review","volume":"7","author":"Whitmore","year":"2020","journal-title":"BMJ Open Respir. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"220","DOI":"10.3340\/jkns.2013.54.3.220","article-title":"The Effectiveness of Early Tracheostomy (within at least 10 Days) in Cervical Spinal Cord Injury Patients","volume":"54","author":"Choi","year":"2013","journal-title":"J. Korean Neurosurg. Soc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"375S","DOI":"10.1378\/chest.120.6_suppl.375S","article-title":"Evidence-based guidelines for weaning and discontinuing ventilatory support: A collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine","volume":"120","author":"MacIntyre","year":"2001","journal-title":"Chest"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1097\/TA.0000000000003394","article-title":"Timing of tracheostomy in acute traumatic spinal cord injury: A systematic review and meta-analysis","volume":"92","author":"Foran","year":"2022","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Huang, H., Li, Y., Ariani, F., Chen, X., and Lin, J. (2014). Timing of tracheostomy in critically ill patients: A meta-analysis. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0092981"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e458","DOI":"10.18295\/squmj.2016.16.04.009","article-title":"Early Versus Late Tracheostomy for Patients with High and Low Cervical Spinal Cord Injuries","volume":"16","author":"Guirgis","year":"2016","journal-title":"Sultan Qaboos Univ. Med. J."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Zarmer, L., Khan, M., Islat, G., Alameddin, H., Massey, M., and Chaudhry, R. (2025). Traumatic Spinal Cord Injury: Review of the Literature. J. Clin. Med., 14.","DOI":"10.3390\/jcm14113649"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1017\/S0317167100014530","article-title":"Global incidence and prevalence of traumatic spinal cord injury","volume":"40","author":"Furlan","year":"2013","journal-title":"Can. J. Neurol. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"658","DOI":"10.31616\/asj.2021.0301","article-title":"Patterns of Traumatic Spinal Injuries in the Developing World: A Five-Year Longitudinal Review","volume":"16","author":"Kanna","year":"2022","journal-title":"Asian Spine J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2147\/JN.S143236","article-title":"Epidemiology of worldwide spinal cord injury: A literature review","volume":"6","author":"Kang","year":"2018","journal-title":"J. Neurorestoratol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e0298836","DOI":"10.1371\/journal.pone.0298836","article-title":"Changing trends in traumatic spinal cord injury in an aging society: Epidemiology of 1152 cases over 15 years from a single center in Japan","volume":"19","author":"Yokota","year":"2024","journal-title":"PLoS ONE"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1097\/TA.0b013e318251fb34","article-title":"Predicting the need for tracheostomy in patients with cervical spinal cord injury","volume":"73","author":"Leelapattana","year":"2012","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1613","DOI":"10.1177\/00031348251337147","article-title":"Association of Tracheostomy Timing with Outcomes Following Traumatic Cervical Spinal Cord Injury","volume":"91","author":"Ali","year":"2025","journal-title":"Am. Surg."},{"key":"ref_21","first-page":"168757","article-title":"Respiratory management in the patient with spinal cord injury","volume":"2013","year":"2013","journal-title":"Biomed. Res. Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1177\/1460408616659682","article-title":"Evidence-based respiratory management strategies required to prevent complications and improve outcome in acute spinal cord injury patients","volume":"19","author":"Kumar","year":"2016","journal-title":"Trauma"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1007\/s12975-011-0114-0","article-title":"Respiratory motor control disrupted by spinal cord injury: Mechanisms, evaluation, and restoration","volume":"2","author":"McKay","year":"2011","journal-title":"Transl. Stroke Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"189","DOI":"10.4103\/1673-5374.177707","article-title":"Cardiovascular dysfunction following spinal cord injury","volume":"11","author":"Partida","year":"2016","journal-title":"Neural Regen. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1179\/2045772313Y.0000000114","article-title":"Cardiac arrhythmias associated with spinal cord injury","volume":"36","author":"Hector","year":"2013","journal-title":"J. Spinal Cord Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"E515","DOI":"10.1097\/BRS.0000000000003302","article-title":"Factors Associated with Prolonged Mechanical Ventilation and Reventilation in Acute Cervical Spinal Cord Injury Patients","volume":"45","author":"Wang","year":"2020","journal-title":"Spine"},{"key":"ref_27","unstructured":"McCrory, D.C., Samsa, G.P., Hamilton, B.B., Govert, J.A., Matchar, D.B., Goslin, R.E., and Kolimaga, J.T. (2025, December 01). Treatment of Pulmonary Disease Following Cervical Spinal Cord Injury: Summary 2001 Jun, AHRQ Evidence Report Summaries, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK11884\/."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1080\/10790268.2007.11753946","article-title":"Respiratory management during the first five days after spinal cord injury","volume":"30","author":"Berlly","year":"2007","journal-title":"J. Spinal Cord Med."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Yonemitsu, T., Kinoshita, A., Nagata, K., Morishita, M., Yamaguchi, T., and Kato, S. (2021). Timely intubation with early prediction of respiratory exacerbation in acute traumatic cervical spinal cord injury. BMC Emerg. Med., 21.","DOI":"10.1186\/s12873-021-00530-3"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.pmr.2007.02.001","article-title":"Acute respiratory infections in persons with spinal cord injury","volume":"18","author":"Burns","year":"2007","journal-title":"Phys. Med. Rehabil. Clin. N. Am."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e42946","DOI":"10.1097\/MD.0000000000042946","article-title":"Characteristics of ventilator-associated pneumonia due to Gram-negative bacteria in the intensive care unit: A single-center experience","volume":"104","author":"Aslan","year":"2025","journal-title":"Medicine"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/j.bjae.2021.02.005","article-title":"Laryngeal complications after tracheal intubation and tracheostomy","volume":"21","author":"Wallace","year":"2021","journal-title":"BJA Educ."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1097\/CCM.0000000000005125","article-title":"ICU Survivorship-The Relationship of Delirium, Sedation, Dementia, and Acquired Weakness","volume":"49","author":"Mart","year":"2021","journal-title":"Crit. Care Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1186\/s13613-021-00938-x","article-title":"Separation from mechanical ventilation and survival after spinal cord injury: A systematic review and meta-analysis","volume":"11","author":"Schreiber","year":"2021","journal-title":"Ann. Intensive Care"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"18","DOI":"10.4103\/1817-1737.37949","article-title":"Experience with 224 percutaneous dilatational tracheostomies at an adult intensive care unit in Bahrain: A descriptive study","volume":"3","author":"Hameed","year":"2008","journal-title":"Ann. Thorac. Med."},{"key":"ref_36","first-page":"51","article-title":"Tracheostomy, ventilation and anterior cervical surgery: Timing and Complications","volume":"53","author":"Kruger","year":"2015","journal-title":"S Afr. J. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.pulmoe.2020.07.002","article-title":"The role of non-invasive ventilation in weaning and decannulating critically ill patients with trache-ostomy: A narrative review of the literature","volume":"27","author":"Guia","year":"2021","journal-title":"Pulmonology"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/S0377-1237(17)30440-9","article-title":"Tracheostomy Complications and Their Management","volume":"55","author":"Mehta","year":"1999","journal-title":"Med. J. Armed Forces India"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1097\/LBR.0000000000000177","article-title":"Tracheostomy Tube Placement: Early and Late Complications","volume":"22","author":"Mahajan","year":"2015","journal-title":"J. Bronchol. Interv. Pulmonol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"R347","DOI":"10.1186\/cc2924","article-title":"Early tracheostomy in intensive care trauma patients improves resource utilization: A cohort study and literature review","volume":"8","author":"Arabi","year":"2004","journal-title":"Crit. Care"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1097\/TA.0000000000002045","article-title":"Safety of early tracheostomy in trauma patients after anterior cervical fusion","volume":"85","author":"Lozano","year":"2018","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.1097\/01.CCM.0000134835.05161.B6","article-title":"A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients","volume":"32","author":"Rumbak","year":"2004","journal-title":"Crit. Care Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1186\/s13054-015-1138-8","article-title":"Timing of tracheotomy in ICU patients: A systematic review of randomized controlled trials","volume":"19","author":"Hosokawa","year":"2015","journal-title":"Crit. Care"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e24329","DOI":"10.1097\/MD.0000000000024329","article-title":"Early versus late tracheotomy in ICU patients: A meta-analysis of randomized controlled trials","volume":"100","author":"Deng","year":"2021","journal-title":"Medicine"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1452","DOI":"10.1007\/s00586-009-1097-3","article-title":"Tracheostomy timing in traumatic spinal cord injury","volume":"18","author":"Romero","year":"2009","journal-title":"Eur. Spine J."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1179\/107902610X12886261091875","article-title":"Effect of technique and timing of tracheostomy in patients with acute traumatic spinal cord injury undergoing mechanical ventilation","volume":"34","author":"Ganuza","year":"2011","journal-title":"J. Spinal Cord Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"191","DOI":"10.4055\/cios.2018.10.2.191","article-title":"The Need for Early Tracheostomy in Patients with Traumatic Cervical Cord Injury","volume":"10","author":"Beom","year":"2018","journal-title":"Clin. Orthop. Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1097\/BRS.0000000000002537","article-title":"Early Tracheostomy in Patients with Traumatic Cervical Spinal Cord Injury Appears Safe and May Improve Outcomes","volume":"43","author":"Flanagan","year":"2018","journal-title":"Spine"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1097\/TA.0000000000002758","article-title":"Time to tracheostomy impacts overall outcomes in patients with cervical spinal cord injury","volume":"89","author":"Anand","year":"2020","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1016\/j.amjsurg.2020.01.054","article-title":"Early tracheostomy in patients with cervical spine injury reduces morbidity and improves resource utilization","volume":"220","author":"Khan","year":"2020","journal-title":"Am. J. Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e304","DOI":"10.1016\/j.wneu.2020.05.044","article-title":"Early Percutaneous Dilational Tracheostomy in Trauma Patients After Anterior Cervical Fusion: Propensity-Matched Cohort Study","volume":"140","author":"Shan","year":"2020","journal-title":"World Neurosurg."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"106947","DOI":"10.1016\/j.clineuro.2021.106947","article-title":"Comparison of clinical outcomes of tracheotomy in patients with acute cervical spinal cord injury at different timing","volume":"210","author":"Wang","year":"2021","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Sun, L., Feng, H., Mei, J., Wang, Z., Deng, C., Qin, Z., and Lv, J. (2023). One-stage tracheostomy during surgery reduced early pulmonary infection and mechanical ventilation length in complete CSCI patients. Front. Surg., 9.","DOI":"10.3389\/fsurg.2022.1082428"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"107577","DOI":"10.1016\/j.clineuro.2022.107577","article-title":"Tracheostomy in traumatic cervical spinal cord injury: Early versus late tracheostomy","volume":"224","author":"Sun","year":"2023","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"3064","DOI":"10.1177\/00031348231157855","article-title":"Delayed Tracheostomy After Cervical Fixation is Not Associated with Improved Outcomes: A Trauma Quality Improvement Program Analysis","volume":"89","author":"Kelly","year":"2023","journal-title":"Am. Surg."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1227\/neu.0000000000002575","article-title":"Earlier Tracheostomy Reduces Complications in Complete Cervical Spinal Cord Injury in Real-World Practice: Analysis of a Multicenter Cohort of 2001 Patients","volume":"93","author":"Balas","year":"2023","journal-title":"Neurosurgery"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1227\/neu.0000000000002892","article-title":"Quantifying the Association Between Surgical Spine Approach and Tracheostomy Timing After Traumatic Cervical Spinal Cord Injury","volume":"95","author":"Essa","year":"2024","journal-title":"Neurosurgery"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1213\/ANE.0000000000005212","article-title":"Early Versus Late Tracheostomy in Patients with Acute Traumatic Spinal Cord Injury: A Systematic Review and Meta-analysis","volume":"132","author":"Mubashir","year":"2021","journal-title":"Anesth. Analg."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"108968","DOI":"10.1016\/j.clineuro.2025.108968","article-title":"The impact of tracheostomy timing on the outcomes of patients with acute traumatic spinal cord injury: A systematic review and meta-analysis","volume":"255","author":"Zameni","year":"2025","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"124707","DOI":"10.1016\/j.wneu.2025.124707","article-title":"Timing of Tracheostomy After Anterior Cervical Decompression in Traumatic Cervical Spinal Cord Injury: A Systematic Review and Meta-Analysis","volume":"205","author":"Coffin","year":"2026","journal-title":"World Neurosurg."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"2","DOI":"10.4103\/1658-354X.62606","article-title":"Effect of tracheostomy on pulmonary mechanics: An observational study","volume":"4","author":"Sofi","year":"2010","journal-title":"Saudi J. Anaesth."},{"key":"ref_62","first-page":"56","article-title":"Timing of Tracheostomy and Association with Ventilator Liberation, Length of Stay, and Discharge Outcomes in Neurocritical Patients","volume":"2","author":"Amano","year":"2025","journal-title":"Tracheostomy"},{"key":"ref_63","first-page":"5895830","article-title":"A Meta-Analysis of the Influencing Factors for Tracheostomy after Cervical Spinal Cord Injury","volume":"2018","author":"Wang","year":"2018","journal-title":"Biomed. Res. Int."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1179\/2045772311Y.0000000024","article-title":"Factors associated with early mortality after cervical spinal cord injury","volume":"34","author":"Shao","year":"2011","journal-title":"J. Spinal. Cord. Med."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1186\/s13613-023-01217-7","article-title":"Predicting extubation in patients with traumatic cervical spinal cord injury using the diaphragm electrical activity during a single maximal maneuver","volume":"13","author":"Zhang","year":"2023","journal-title":"Ann. Intensive Care"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1016\/j.surg.2022.06.050","article-title":"Observational study of early diaphragm pacing in cervical spinal cord injured patients to decrease mechanical ventilation during the COVID-19 pandemic","volume":"173","author":"Onders","year":"2023","journal-title":"Surgery"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Tekin, P., and Bulut, A. (2024). Tracheostomy Timing in Unselected Critically Ill Patients with Prolonged Intubation: A Prospective Cohort Study. J. Clin. Med., 13.","DOI":"10.3390\/jcm13102729"},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Lu, M., Wei, J., and Cai, Q. (2026). Impact of early vs. late tracheostomy on clinical outcomes in mechanically ventilated patients with intracerebral hemorrhage extending into the ventricles: A retrospective cohort study based on quantitative assessment of parenchymal and intraventricular hematoma volumes. Front. Neurol., 17.","DOI":"10.3389\/fneur.2026.1724717"},{"key":"ref_69","first-page":"350","article-title":"Beneficial Outcomes of Early Tracheostomy in Patients Requiring Prolonged Mechanical Ventilation","volume":"19","author":"Khoundabi","year":"2020","journal-title":"Tanaffos"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1111\/anae.16198","article-title":"Management of acute cervical spinal cord injury in the non-specialist intensive care unit: A narrative review of current evidence","volume":"79","author":"Wiles","year":"2024","journal-title":"Anaesthesia"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1097\/JTN.0000000000000756","article-title":"A Fast-Track Respiratory Protocol for High Cervical Spine Injury: A Case Report","volume":"30","author":"Pan","year":"2023","journal-title":"J. Trauma Nurs."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.1080\/09638288.2016.1189607","article-title":"Implementation of a respiratory rehabilitation protocol: Weaning from the ventilator and tracheostomy in difficult-to-wean patients with spinal cord injury","volume":"39","author":"Gundogdu","year":"2017","journal-title":"Disabil. Rehabil."},{"key":"ref_73","unstructured":"(2025, October 09). Placement of Tracheostomy Following Cervical Stabilization. Best Practices Guidelines: Spine Injury. Available online: https:\/\/www.facs.org\/media\/k45gikqv\/spine_injury_guidelines.pdf."},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Moreno-Gonz\u00e1lez, E., and Ibarra, A. (2024). The Critical Management of Spinal Cord Injury: A Narrative Review. Clin. Pract., 15.","DOI":"10.3390\/clinpract15010002"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"2121","DOI":"10.1001\/jama.2013.5154","article-title":"Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: The TracMan randomized trial","volume":"309","author":"Young","year":"2013","journal-title":"JAMA"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1097\/ANA.0b013e31829770a0","article-title":"Effect of tracheostomy timing on clinical outcome in neurosurgical patients: Early versus late tracheostomy","volume":"26","author":"Jeon","year":"2014","journal-title":"J. Neurosurg. Anesthesiol."},{"key":"ref_77","first-page":"20","article-title":"Tracheostomy placement in patients with complete cervical spinal cord injuries: American Spinal Injury Association Grade A","volume":"100","author":"Harrop","year":"2004","journal-title":"J. Neurosurg."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1007\/s12028-016-0297-z","article-title":"Effect of Early Versus Late Tracheostomy or Prolonged Intubation in Critically Ill Patients with Acute Brain Injury: A Systematic Review and Meta-Analysis","volume":"26","author":"McCredie","year":"2017","journal-title":"Neurocrit Care"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"116033","DOI":"10.1016\/j.amjsurg.2024.116033","article-title":"Clinical risk factors associated with the need for tracheostomy in traumatic cervical and high thoracic spinal cord injury","volume":"239","author":"Konrad","year":"2025","journal-title":"Am. J. Surg."},{"key":"ref_80","first-page":"656","article-title":"Tracheostomy in spinal cord injured: Frequency and follow up","volume":"30","year":"1992","journal-title":"Paraplegia"}],"container-title":["Neurology International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2035-8377\/18\/5\/85\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T11:38:31Z","timestamp":1777549111000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2035-8377\/18\/5\/85"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,30]]},"references-count":80,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["neurolint18050085"],"URL":"https:\/\/doi.org\/10.3390\/neurolint18050085","relation":{},"ISSN":["2035-8377"],"issn-type":[{"value":"2035-8377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,30]]}}}