The Respiratory System in Spinal Cord Injury

Lanig, Indira S.; Lammertse, Daniel P.

doi:10.1016/s1047-9651(18)30613-2

Cited by 14 publications

(29 citation statements)

References 30 publications

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“…Once the feedings are started, gastric residual volumes need to be monitored. 10 Tracheostomy tubes (TT) are commonly used in individuals with cervical SCI to facilitate ventilation, and many individuals with cervical SCI remain with the TT for a prolonged period of weeks to months. However, tracheostomy places these individuals at high risk for aspiration, dysphagia, and pneumonia.…”

Section: Atelectasis and Secretion Managementmentioning

confidence: 99%

“…Guidelines have been written for interdisciplinary respiratory assessment and treatment for different levels of SCI. 10,16 Strength of cough, the patient's height, thus increasing the work of breathing. Patients ventilated with tidal volumes greater than 20 cc per kilogram of ideal body weight showed decreases in atelectasis and pneumonia, and weaning time decreased significantly.…”

Section: Respiratory Assessmentmentioning

confidence: 99%

“…10 Consortium guidelines on respiratory management recommend the initial laboratory assessment to include arterial blood gas (ABG), complete blood count, chemistry panel, and toxicology screen, chest x-ray, and electrocardiogram (EKG). 5 …”

mentioning

confidence: 99%

See 2 more Smart Citations

Dysphagia and Respiratory Care in Individuals with Tetraplegia: Incidence, Associated Factors, and Preventable Complications

Shem

Castillo

Wong

et al. 2012

Topics in Spinal Cord Injury Rehabilitation

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Section: Atelectasis and Secretion Managementmentioning

confidence: 99%

Section: Respiratory Assessmentmentioning

confidence: 99%

See 1 more Smart Citation

Dysphagia and Respiratory Care in Individuals with Tetraplegia: Incidence, Associated Factors, and Preventable Complications

Shem

Castillo

Wong

et al. 2012

Topics in Spinal Cord Injury Rehabilitation

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“…Because the cough flow and effectiveness are greatly reduced with a cervical SCI, the ability to clear secretions is profoundly affected. 8,9 Aggressive respiratory therapy interventions need to begin immediately after injury, which is further described in detail below. 10 Facilities not familiar with the respiratory impairments of individuals with cervical SCI may manage these individuals in the same manner as they would an individual with nonneuromuscular injuries.…”

mentioning

confidence: 99%

Specialized Respiratory Management for Acute Cervical Spinal Cord Injury: A Retrospective Analysis

Wong¹,

Shem²,

Crew³

2012

Topics in Spinal Cord Injury Rehabilitation

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Background:In individuals with cervical spinal cord injury (SCI), respiratory complications arise within hours to days of injury. Paralysis of the respiratory muscles predisposes the patient toward respiratory failure. Respiratory complications after cervical SCI include hypoventilation, hypercapnea, reduction in surfactant production, mucus plugging, atelectasis, and pneumonia. Ultimately, the patient must use increased work to breathe, which results in respiratory fatigue and may eventually require intubation for mechanical ventilation. Without specialized respiratory management for individuals with tetraplegia, recurrent pneumonias, bronchoscopies, and difficulty in maintaining a stable respiratory status will persist. Objective: This retrospective analysis examined the effectiveness of specialized respiratory management utilized in a regional SCI center. Methods: Individuals with C1-C4 SCI (N = 24) were the focus of this study as these neurological levels present with the most complicated respiratory status. Results: All of the study patients' respiratory status improved with the specialized respiratory management administered in the SCI specialty unit. For a majority of these patients, respiratory improvements were noted within 1 week of admission to our SCI unit. Conclusion: Utilization of high tidal volume ventilation, high frequency percussive ventilation, and mechanical insufflationexsufflation have demonstrated efficacy in stabilizing the respiratory status of these individuals. Optimizing respiratory status enables the patients to participate in rehabilitation therapies, allows for the opportunity to vocalize, and results in fewer days on mechanical ventilation for patients who are weanable.

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“…Findings of breathlessness among subjects with HT4LT4HP4LP is consistent with observations that the severity of overall respiratory impairment following spinal cord injury is inversely associated with the level of lesion. 15 Additional causes for breathlessness in subjects with tetraplegia may include increased work of breathing, 16,17 partial loss of diaphragm and accessory muscle function, 18 paradoxical movement of the chest wall with inspiration, 8,9 reduced lung and chest wall compliance, 3,4 and airway hyperreactivity. 10,11 As a result, among subjects with tetraplegia breaths are more shallow and rapid with a shorter expiratory time, which may predispose to ventilatory muscle fatigue.…”

Section: Discussionmentioning

confidence: 99%

Self-reported prevalence of pulmonary symptoms in subjects with spinal cord injury

et al. 1997

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To determine the prevalence of respiratory symptoms in subjects with chronic spinal cord injury (SCI), 180 subjects completed a standard respiratory questionnaire modi®ed for subjects with limited mobility. Subjects were categorized as high tetraplegia (HT:C5 and above not requiring mechanical ventilation), low tetraplegia (LT: C6 ± 8), high paraplegia (HP: T1 ± 7), or low paraplegia (LP: T8 ± L3). Overall, 68% of subjects reported one or more respiratory symptom. Breathlessness, the most prevalent complaint, was associated with level of lesion: HT=73%, LT=58%, HP=43% and LP=29%, whereas complaints of cough, phlegm, cough and phlegm, and wheeze did not di er signi®cantly among subjects in the four groups. Breathlessness occurred signi®cantly more often in the group with HT during rest or following exposure to hot air or passive smoke. Awareness of phlegm or wheeze was reported with increased prevalence among subjects with tetraplegia who had complete injuries. Among subjects with tetraplegia, respiratory complaints did not di er signi®cantly in current smokers, former smokers, and non-smokers, whereas among subjects with paraplegia, phlegm and wheeze were reported more frequently among current smokers.

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The Respiratory System in Spinal Cord Injury

Cited by 14 publications

References 30 publications

Dysphagia and Respiratory Care in Individuals with Tetraplegia: Incidence, Associated Factors, and Preventable Complications

Dysphagia and Respiratory Care in Individuals with Tetraplegia: Incidence, Associated Factors, and Preventable Complications

Specialized Respiratory Management for Acute Cervical Spinal Cord Injury: A Retrospective Analysis

Self-reported prevalence of pulmonary symptoms in subjects with spinal cord injury

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