Ventilatory Compromise in Spinal Cord Injury—A Review

Saltzstein, Richard J.; Melvin, John L.

doi:10.1080/01952307.1986.11785937

Cited by 9 publications

(6 citation statements)

References 16 publications

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“…Ventilatory compromise and respiratory failure are frequent complications (Huldtgren et al 1980;Saltzstein & Melvin 1986). Impairment in pulmonary function following traumatic myelopathy often occurs concurrently with the impairment in autonomic control, and contributes to the many problems confronting the clinician (Desmond 1970).…”

Section: Pathophysiologymentioning

confidence: 98%

Clinical Pharmacokinetics in Patients with Spinal Cord Injuries

Segal

Brunnemann

1989

Clinical Pharmacokinetics

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Although spinal cord injury is a catastrophic affliction with numerous victims and a variety of physiological manifestations, the associated disarray in physiology has yet to be systematically or comprehensively studied as a probable cause for altered pharmacokinetics. A significant increase in the volume of distribution of drugs such as the aminoglycosides (gentamicin, amikacin, tobramycin), which are highly distributed into the extracellular fluid space and minimally biotransformed, may be anticipated in patients with chronic spinal cord injury. Changes in total body clearance have also been observed for some of these medications. The influence of the pathophysiology of spinal cord injury on gastrointestinal motility appears to be reflected in an impairment in the bioavailability of drugs [theophylline, paracetamol (acetaminophen), doxycycline] which are passively absorbed and which require an intact postprandial gastric emptying to ensure efficient absorption. For theophylline, the impairment in gastrointestinal absorption appears to be directly proportional to both the magnitude of the impairment in gastric emptying and to the neurological level of the injury. Metoclopramide, a gastrointestinal prokinetic drug, has been shown to be extremely effective in normalising the impaired postprandial gastric emptying that characterises spinal cord injury. The systemic absorption of 2 antibiotics (gentamicin and cefotiam) injected into paralysed muscle is also impaired in patients with spinal cord injury, suggesting that a decrease in therapeutic efficacy attributable to this mode of administration may be anticipated. Despite the multiplicity of drugs commonly prescribed for patients with this injury, little is known about the influence of this illness on either bioavailability or postabsorptive pharmacokinetics. For drugs which are biotransformed and which have a relatively small volume of distribution (theophylline, lorazepam, ranitidine), single-dose intravenous pharmacokinetic profiles in patients with spinal cord injury are indistinguishable from the drug disposition profiles characteristic of healthy control populations. It may be inferred, then that the influence of the pathophysiology of spinal cord injury on drug disposition is greatest on those drugs which are the least biotransformed and most likely to be distributed into the increased extracellular fluid volume which is characteristic of patients with this disability.(ABSTRACT TRUNCATED AT 400 WORDS)

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Section: Pathophysiologymentioning

confidence: 98%

Clinical Pharmacokinetics in Patients with Spinal Cord Injuries

Segal

Brunnemann

1989

Clinical Pharmacokinetics

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“…McMichan et al (8), using serial pulmonary function testing, found that there was a greater compromise of expiration than inspiration with time in patients with tetraplegia. Lack of abdominal and chest wall expiratory muscle activity diminishes ability to cough and clear secretions (9). Since ineffective coughing and retention of secretions are the main causes of pulmonary complications such as atelectasis and bronchopulmonary infections in patients with tetraplegia (10), strategies to enhance the effectiveness of coughing and thus improve clearance of bronchial secretions in the acute stage of CSCI are important.…”

Section: Introductionmentioning

confidence: 99%

Effect of Neuromuscular Electrical Stimulation on Cough Capacity and Pulmonary Function in Patients With Acute Cervical Cord Injury

Cheng¹,

Chen²,

Wang³

et al. 2006

Journal of Rehabilitation Medicine

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“…[35][36][37] Both restrictive and obstructive changes in pulmonary function occur simultaneously with acute spinal cord trauma and reflect sudden alterations in the anatomy of the thorax and demodulation of the autonomic nervous system. Theophylline is a bronchodilator of proven efficacy that enhances the strength and prolongs the duration of contraction of the muscles of respiration.…”

Section: Pulmonary Dysfunctionmentioning

confidence: 99%

Optimal Drug Therapy and Therapeutic Drug Monitoring After Spinal Cord Injury: A Population-Specific Approach

Segal

Pathak²

2001

American Journal of Therapeutics

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Study of the clinical pharmacology of SCI has revealed population-specific patterns of drug metabolism and disposition. PD/PK profiles reflect the changed physiology associated with SCI and correlate well with the neurologic or anatomic level and the magnitude and completeness of the injury. The greatest value of SCI PK/PD profiles lies in their use in developing criteria and strategies for the optimal prescribing of drugs and in therapeutic drug monitoring. Patients with SCI, acute or long-standing, comprise a therapeutically unique and distinct population. Rational, efficacious, and cost-effective approaches to drug development and pharmacotherapy in spinal cord-injured patients can only come about when population-specific PK/PD behavior is incorporated early into the drug development process and used to develop safe, effective therapeutic guidelines.

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Ventilatory Compromise in Spinal Cord Injury—A Review

Cited by 9 publications

References 16 publications

Clinical Pharmacokinetics in Patients with Spinal Cord Injuries

Clinical Pharmacokinetics in Patients with Spinal Cord Injuries

Effect of Neuromuscular Electrical Stimulation on Cough Capacity and Pulmonary Function in Patients With Acute Cervical Cord Injury

Optimal Drug Therapy and Therapeutic Drug Monitoring After Spinal Cord Injury: A Population-Specific Approach

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