In cases above C4 cervical cord injury a respiratory distress and serious pulmonary complications occur with frequent obstruction of air way by increased excretion and difficult evacuation. Long term tracheal intubation often provides many general complications. We analized advantage and demerit of early tracheotomy in such cases of cervical cord injury patients.

Material and Methods: 1) We proposed early tracheotomy to prevent complications and ease respiration when pts showed low vital capacity (v.c.) less than 500cc showing deltoid/biceps palsy and respiratory distress with much excretion and difficult evacuation. 2) We have analysed 91 patients who needed ventilator out of 845 cervical cord injury patients who admitted in our hospital. 2) 25 pts were treated by tracheotomy from the beginning of treatment, and others were switched over from management of tracheal intubation. 3) We used a double cuff tracheotomy tube to prevent continuous pressure to the tracheal wall. 4) Weaning from ventilator was done when Fi02< 0.3, PEEP< 5cmH2O and PaO2> 80mmHg in room air.

Results: 1) 4 (16%) out of 25 pts who had been treated with tracheotomy from the beginning had atelectasis, whereas 15 (23%) out of 66 pts treated with intubation occurred that symtome, and 20% of the pts suffered pneumonia. 2) Out of 46 pts treated with intratracheal intubation in the beginning and then changed to tracheotomy within 4 days 7(15%) had atelectasis, whereas 20 (29%) of the pts who underwent tracheotomy after 5 days occurred the complication. 3) As complication of tracheotomy? Infection and? tracheal stenosis were observed but all uneventful healed.

Discussion/Conclusion: 1) Acutecervical cord injury pts showing deltoid/biceps palsy have impending respiratory distress. Examination of spirometer is essential. In such cases low v.c. < 500 tracheotomy should be indicated. 2) Continuing respiratory distress > 4days of intubation it is advised tracheotomy in order to prevent genera l complications. 3) Combination with frequent position changing and chest tapping is also essential for evacuation.