Successful weaning from mechanical ventilation in the quadriplegia patient with C2 spinal cord injury undergoing C2-4 spine laminoplasty -A case report-

Abstract

In patients with cervical spine injuries, respiratory function requires careful attention. Voluntary respiratory control is usually possible with lesions below C4 level although paralysis of the abdominal musculature results in a decreased ability to cough and to clear secretions, which may later lead to respiratory insufficiency. Therefore, injuries above C5 usually necessitate long term mechanical ventilation. Even though weaning criteria are not definitive for the quadriplegic patient, M-mode ultrasonography of the diaphragm may be useful in identifying patients at high risk of difficulty weaning. Diaphragmatic dysfunction (vertical excursion < 10 mm or paradoxical movements) results in frequent early and delayed weaning failures. We present our clinical experience with successful weaning by using M-mode ultrasonography and a cough-assist device for secretion clearance after extubation in a quadriplegic patient undergoing C2-4 spine laminoplasty.

Preliminary experience on the safety and tolerability of mechanical “insufflation-exsufflation” in subjects with artificial airway

“…The combination of post-extubation non-invasive mechanical ventilation with pre- and post-extubation MIE was associated with successful extubation in a population of 157 “unweanable” patients, 89% of whom suffered from NMD [ 18 ]. Another publication describes a single case of traumatic quadriplegia successfully weaned from mechanical ventilation supported in part by MIE applied immediately after extubation [ 17 ]. A small study with a historical control group showed a reduction in the number of subjects needing endotracheal intubation for invasive mechanical ventilation in a group of patients with NMD admitted to intensive care for acute respiratory insufficiency with or without respiratory tract infections, in whom MIE was applied with a face mask [ 10 ].…”

Functional state of the diaphragm in patients with cervical spinal cord injury at the stages of respiratory support

“…Столь высокие показатели неудачных попыток перевода пациентов с травмой спинного мозга на самостоятельное дыхание обусловлены особенностями патогенеза дыхательной недостаточности, в частности, диафрагма зачастую остается единственной дыхательной мышцей, обеспечивающей почти 75 % легочной вентиляции у данной категории пациентов. Сохранение ее функционального состояния является одной из основных задач при определении тактики ИВЛ [3,10].…”