Respiratory Mechanics in Acute Quadriplegia: Lung and Chest Wall Compliance and Dimensional Changes during Respiratory Maneuvers

Scanlon, Paul D.; Loring, S. H.; Pichurko, Bohdan; McCool, F. Dennis; Slutsky, A. S.; Sarkarati, Mehdi; Brown, Robert H.

doi:10.1164/ajrccm/139.3.615

Cited by 79 publications

(39 citation statements)

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“…25 The ®ndings in our study show that VC can increase within and up to 10 years post injury without any structured respiratory program. Only two other studies documented late VC increases without a structured respiratory program.…”

Section: Discussionsupporting

confidence: 47%

Vital capacity in tetraplegics twenty years and beyond

2001

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Objectives: To observe the trends in vital capacity (VC) over time in tetraplegics 20 years and more after injury, the e ects of age at injury, severity of injury and gender on this trend. Methods: The medical records of all spinal cord injured persons admitted to a regional spinal injury center from January 1960 to December 1996 were reviewed. Fifty-seven patients had documented post-rehabilitation VC (mean 1.3+1.1 years) and VC at 10 (mean 11.8+2.69) and 20 (20.60+2.67) years post injury and beyond. Results: The mean age at injury was 23.2+9.1 years. Severity of injury when classi®ed according the system proposed by Coll et al were: Group 1: C1 ± 4 Frankel A injury: 11.6%, Group 2: C5 ± 8 Frankel A injury: 55.6%, Group 3: C2 ± 8 Frankel B and C: 29.8% and Group 4: C2 ± 8 Frankel D: 3.5% respectively. The mean VC at initial, 10 and 20 years post injury was 2586+948, 2803+940 and 2525+818 cc respectively. Multivariate analysis of variance revealed that there was signi®cant di erence in VC over a 20 year period, (F(2,54)=8.43, P50.05). The di erence between VC at 10 years and VC at 20 years accounted for the 19.8% of the variance in VC over time (F(1,55)=12.35, P50.05). Age at injury, gender and severity of injury did not have a signi®cant in¯uence on the rate of decline in VC. Analysis of a subset of 26 patients who were followed up more than 20 years post injury (range 22 to 34.5 years) revealed similar,

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Section: Discussionsupporting

confidence: 47%

Vital capacity in tetraplegics twenty years and beyond

2001

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“…7 Although SCI level and completeness of injury were not directly related to mortality, it is likely that SCI still influences mortality indirectly via the factors identified in the multivariate models. For example, SCI results in respiratory muscle weakness as well as changes in chest wall and lung compliance, 29,30 and it is recognized that higher neurological level and greater completeness of injury are associated with lower levels of pulmonary function. Preliminary observations suggest that cigarette smoking leads to a greater than expected accelerated loss of lung function in SCI.…”

Section: Discussionmentioning

confidence: 99%

A prospective assessment of mortality in chronic spinal cord injury

et al. 2005

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Study design: Prospective mortality study. Objective: To assess the relationship between comorbid medical conditions and other healthrelated factors to mortality in chronic spinal cord injury (SCI). Setting: Boston, MA, USA. Methods: Between 1994 and 2000, 361 males X1 year after injury completed a respiratory health questionnaire and underwent pulmonary function testing. Cause-specific mortality was assessed over a median of 55.6 months (range 0.33-74.4 months) through 12/31/2000 using the National Death Index. Results: At entry, mean (7SD) age was 50.6715.0 years (range 23-87) and years since injury was 17.5712.8 years (range 1.0-56.5). Mortality was elevated (observed/expected deaths ¼ 37/ 25.1; SMR ¼ 1.47; 95% CI ¼ 1.04-2.03) compared to US rates. Risk factors for death were diabetes (RR ¼ 2.62; 95% CI ¼ 1.19-5.77), heart disease (RR ¼ 3.66; 95% CI ¼ 1.77-7.78), reduced pulmonary function, and smoking. The most common underlying and contributing causes of death were diseases of the circulatory system (ICD-9 390-459) in 40%, and of the respiratory system in 24% (ICD-9 460-519). Conclusions: These results suggest that much of the excess mortality in chronic SCI is related to potentially treatable factors. Recognition and treatment of cardiovascular disease, diabetes, and lung disease, together with smoking cessation may substantially reduce mortality in chronic SCI.Spinal Cord (2005) 43, 408-416.

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“…Crosssectional studies, including our own, have described a significant age-independent association between years of injury and lower values of FEV 1 and FVC that were greatest in persons with higher and more neurologically complete SCI (4,14,15). After SCI, lung and rib cage compliance decrease, a process that could account for an effect of injury duration on decline in FEV 1 and FVC (24,25). In the current study, we also describe an effect of years postinjury on FEV 1 in persons with motor complete and ASIA C quadriplegia and paraplegia.…”

Section: Discussionmentioning

confidence: 94%

Longitudinal Change in FEV₁ and FVC in Chronic Spinal Cord Injury

Stolzmann

Gagnon²,

Brown³

et al. 2008

Am J Respir Crit Care Med

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Rationale: Although respiratory dysfunction is common in chronic spinal cord injury (SCI), determinants of longitudinal change in FEV 1 and FVC have not been assessed. Objectives: Determine factors that influence longitudinal lung function decline in SCI. Methods: A total of 174 male participants (mean age of 49 and 17 yr after injury) completed a respiratory questionnaire and underwent spirometry over an average follow-up of 7.5 years (range, 4-14 yr). Measurements and Main Results: In multivariate models, longitudinal decline in FEV 1 was significantly related to continued smoking, persistent wheeze, an increase in body mass index, and respiratory muscle strength. Aging was associated with an accelerated decline in FEV 1 (for ages ,40, 40-60, .60 yr: 227, 237, and 271 ml/yr, respectively). Similar effects were observed for FVC. Conclusions: Longitudinal change in FEV 1 and FVC was not directly related to level and severity of SCI, but was attributable to potentially modifiable factors in addition to age. These results suggest that weight control, smoking cessation, trials directed at the recognition and treatment of wheeze, and efforts to improve respiratory muscle strength may slow lung function decline after SCI.Keywords: respiratory function; longitudinal studies; smoking; body mass index Diseases of the respiratory system are an important cause of morbidity and mortality in persons with chronic spinal cord injury (SCI) (1-3). Although there is improvement in pulmonary function over the first postinjury year, the natural history of change in pulmonary function after this time period has not been described. We established the VA Boston SCI Health Study to assess determinants of respiratory health and pulmonary function in chronic SCI and have reported that a lower FEV 1 and FVC at study entry was associated with an increased risk of dying over a median of 4.5 years (3). In addition to age and SCI level and completeness of injury, significant crosssectional determinants of pulmonary function were lifetime pack-years smoked, persistent wheeze, respiratory muscle performance, and years since injury (4).Because SCI results in muscle paralysis that is determined by the neurologic level and completeness of injury, higher neurologic level and more complete injury will result in a greater degree of respiratory muscle dysfunction and a reduction in pulmonary function (i.e., FEV 1 and FVC) (5). However, there are not any reports describing whether persons with a higher neurologic level and more complete injury will have a more rapid longitudinal decline in FEV 1 and FVC than persons with less severe SCI or if other risk factors are important. In this study, we have extensively characterized potential risk factors for lung function decline with the goal of prospectively identifying factors associated with longitudinal change in FEV 1 and FVC in a cohort of persons with chronic SCI. Some of these results have been previously reported in the form of an abstract (6). METHODSBetween 1994 and 2001, 426 participants free fro...

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Respiratory Mechanics in Acute Quadriplegia: Lung and Chest Wall Compliance and Dimensional Changes during Respiratory Maneuvers

Cited by 79 publications

References 1 publication

Vital capacity in tetraplegics twenty years and beyond

Vital capacity in tetraplegics twenty years and beyond

A prospective assessment of mortality in chronic spinal cord injury

Longitudinal Change in FEV₁ and FVC in Chronic Spinal Cord Injury

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Respiratory Mechanics in Acute Quadriplegia: Lung and Chest Wall Compliance and Dimensional Changes during Respiratory Maneuvers

Cited by 79 publications

References 1 publication

Vital capacity in tetraplegics twenty years and beyond

Vital capacity in tetraplegics twenty years and beyond

A prospective assessment of mortality in chronic spinal cord injury

Longitudinal Change in FEV1 and FVC in Chronic Spinal Cord Injury

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Product

Resources

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Longitudinal Change in FEV₁ and FVC in Chronic Spinal Cord Injury