AIRWAY MANAGEMENT IN PATIENTS WITH TRAUMATIC SPINAL CORD INJURY: A SYSTEMATIC REVIEW

Introduction: Airway management in patients with traumatic spinal cord injury is a high-stakes component of acute trauma care because inadequate oxygenation, repeated airway attempts, and excessive cervical motion may worsen neurological and systemic outcomes. Respiratory compromise is particularly relevant in cervical injuries, in which early airway decisions may influence both immediate survival and subsequent ventilatory dependence. Objective: To systematically evaluate the current evidence on airway management strategies in patients with traumatic spinal cord injury, with emphasis on initial intubation techniques, cervical motion restriction during airway intervention, tracheostomy timing, and downstream respiratory outcomes. Methods: A systematic review was conducted using PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and ICTRP. Eligible studies addressed airway management in traumatic spinal cord injury or directly relevant traumatic cervical spinal injury contexts, with priority given to human studies published within the predefined recent time window and expanded when necessary according to protocol. Study selection, data extraction, and methodological appraisal were structured according to PRISMA, with risk of bias assessed using RoB 2, ROBINS-I, or QUADAS-2 as appropriate, and certainty of evidence interpreted using GRADE. Results and Discussion: Twenty studies were included in the final qualitative synthesis. The most consistent findings supported videolaryngoscopy as the preferred modern approach for initial tracheal intubation when cervical motion restriction is required, owing to better glottic visualization, higher first-pass success, and improved procedural efficiency in comparison with conventional techniques. The tracheostomy literature was more robust than the emergency intubation literature and consistently suggested that earlier tracheostomy was associated with shorter mechanical ventilation, shorter intensive care stay, shorter hospitalization, and fewer pulmonary complications, although mortality benefit remained uncertain. Additional evidence suggested clinically relevant roles for structured extubation assessment, dysphagia surveillance, decannulation planning, and selected use of diaphragm pacing in high cervical injury. Conclusion: Current evidence favors a longitudinal, multidisciplinary airway strategy in traumatic spinal cord injury that combines expert initial airway control with early anticipation of prolonged respiratory support needs. Videolaryngoscopy appears to be the most consistently advantageous option for initial instrumentation under cervical motion restriction, while early tracheostomy should be considered in patients with severe cervical injury and high risk of sustained ventilatory dependence. More prospective multicenter studies are needed to strengthen the evidence base in real-world trauma settings.