Respiratory and metabolic management in acute tetraplegia

Abstract

THE management of a patient with acute tetraplegia is beset with many different problems. The problems may be divided into those associated with the injury to the spine and spinal cord, those associated with other common complications such as head, chest and limb injuries, and those associated with the respiratory and metabolic consequences of this type of injury. The term injury includes not only the accidental trauma but also, where necessary, subsequent operative treatment, with or without general anaesthesia. On occasions there may be days or even weeks between these components of the 'injury'. In a previous paper (Cheshire, 1964) a broad plan for respiratory assessment and management was suggested, and while the hypoventilation syndrome, the management of a tracheostomy and the effects of body temperature on the oxygen requirements of the tetraplegic patient will be discussed in this paper, its primary purpose is to present the special metabolic problems of the acute tetraplegic and to propose a regime for the coordinated treatment of respiratory and metabolic states. I Since Volume (Yrs) Lesion Accident Capacity (Months) (ml) (ml) l. (G. B.) 21 Complete below C6 3 310 2200 , 2. (B.R.) 27 Complete below C6 3 460 2000 3. (D. C.) 14 Complete below C6 4 445 2000 4. (A.M.) 19 Complete below C5 23 500 1950 5. (B. P.) 28 Complete below C5 33 530 3000 6. (B. S.) 29 Complete below C5 38 250 1500 7. (A. P) 46 Complete below C6 39 470 1550 8.

Characterizing the need for tracheostomy placement and decannulation after cervical spinal cord injury

“…Pulmonary complications are the most common complications in patients with C-SCI [7,9]. Eighty percent of deaths among patients with C-SCI are secondary to pulmonary dysfunction, with pneumonia being the aetiology in 50 % cases [3].…”

“…Such injuries are often associated with neurological deficits, and respiratory dysfunction secondary to the injury can be a major for patients with C-SCI patients with them [7,9]. Respiratory dysfunction is the biggest cause of death after C-SCI in such patients, and pneumonia or atelectasis often occurs after the injury [3,7,9].…”

The use of operant conditioning techniques in the respiratory rehabilitation of the tetraplegic

“…In a previous paper by one of us (Cheshire et al, 1966) the respiratory function of an experimental group of ten tetraplegic patients was investigated. All these patients were male, all had complete lesions of the cervical spinal cord below C5 or C6, all had com plete absence of any pre-accident history of respiratory disease and all were in a state of respiratory stability.…”

Minitracheotomy in the early respiratory management of patients with spinal injuries

“…The majority of early deaths of patients with spinal cord injuries are due to respiratory complications (Tribe, 1963;Cheshire, 1964;Cheshire and Foster, 1964;Cheshire, 1966;Silver and Gibbon, 1968;Bellamy et al, 1973;Kiwerski et al, 1981;Carter, 1987). Carter stated that nearly 70 'jo of all spinal injuries in his review might be expected to have a marked predisposition for respiratory problems.…”

“…Various methods have been tried to clear the major airways of secretions including fibre optic laryngoscopy (Cheshire and Coats, 1965) and modified Magill's tube for endobronchial suction (Cheshire and Foster, 1964).…”