Acute Ventilator Management and Weaning in Individuals with High Tetraplegia

Wallbom, Agnes; Naran, Bindu; Thomas, Evelyn

doi:10.1310/k4y4-ydxq-9vny-f562

Cited by 16 publications

(29 citation statements)

References 1 publication

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“…31 The use of HVtV, HFPV, and MIE implemented in our SCI unit by respiratory care practitioners in the prevention and treatment of respiratory complications has demonstrated improved outcomes for those with cervical SCI. 16,32,33 However, in patients with significant comorbidities, weaning may not occur successfully. For example, one patient (C4 AIS B) who had a premorbid history of obesity, asthma, diabetes, and cancer and who was diagnosed with dysphagia was not able to wean off the ventilator for 24 hours daily but required nighttime ventilation and had one bronchoscopy performed while in the SCI unit.…”

Section: Discussionmentioning

confidence: 99%

“…25 Although there are several published reports and guidelines supporting the use of MIE in individuals with SCI, there is no evidence-based literature describing or supporting the use of HFPV specifically for SCI. 3,21,31,32 The limitation of this study is that we cannot specifically describe the effectiveness of just HFPV or MIE in this patient population because a combination of respiratory care interventions (HVtV, HFPV, and MIE) was used in almost all of the subjects. The efficacy and safety of the use of HVtV have been previously reported.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

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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“…Aggressive pulmonary management measures have been shown to improve outcomes in SCI. 12 Stabilization of the patient's respiratory status by appropriate aggressive respiratory care interventions that have been proven effective for the cervical SCI patient allows the SLP the opportunity to perform the dysphagia evaluation. Enabling the ventilated or tracheostomized SCI patient to vocalize early in the rehabilitation course is important for multiple reasons: (1) It minimizes isolation and any frustration that is associated with the patient's inability to communicate, thereby improving overall mood and socialization; and (2) it optimizes the interaction with medical and rehabilitation providers of the interdisciplinary team during the acute rehabilitation course.…”

Section: Dysphagia Considerations In Respiratory Managementmentioning

confidence: 99%

Dysphagia and Associated Respiratory Considerations in Cervical Spinal Cord Injury

Chaw

Shem

Castillo

et al. 2012

Topics in Spinal Cord Injury Rehabilitation

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Background: Dysphagia is a relatively common secondary complication that occurs after acute cervical spinal cord injury (SCI). The detrimental consequences of dysphagia in SCI include transient hypoxemia, chemical pneumonitis, atelectasis, bronchospasm, and pneumonia. The expedient diagnosis of dysphagia is imperative to reduce the risk of the development of life-threatening complications. Objective: The objective of this study was to identify risk factors for dysphagia after SCI and associated respiratory considerations in acute cervical SCI. Methods: Bedside swallow evaluation (BSE) was conducted in 68 individuals with acute cervical SCI who were admitted to an SCI specialty unit. Videofluroscopy swallow study was conducted within 72 hours of BSE when possible. Results: This prospective study found dysphagia in 30.9% (21 out of 68) of individuals with acute cervical SCI. Tracheostomy (P = .028), ventilator use (P = .012), and nasogastric tube (P = .049) were found to be significant associated factors for dysphagia. Furthermore, individuals with dysphagia had statistically higher occurrences of pneumonia when compared with persons without dysphagia (P < .001). There was also a trend for individuals with dysphagia to have longer length of stay (P = .087). Conclusion: The role of respiratory care practitioners in the care of individuals with SCI who have dysphagia needs to be recognized. Aggressive respiratory care enables individuals with potential dysphagia to be evaluated by a speech pathologist in a timely manner. Early evaluation and intervention for dysphagia could decrease morbidity and improve overall clinical outcomes.

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“…17 Emphasis should be on lung expansion and loosening and expelling secretions to prevent mucus plugs. Intermittent positive pressure breathing (IPPB) is a lung expansion treatment that is usually used with a bronchodilator.…”

Section: Atelectasis and Secretion Managementmentioning

confidence: 99%

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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Acute Ventilator Management and Weaning in Individuals with High Tetraplegia

Cited by 16 publications

References 1 publication

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

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

Dysphagia and Associated Respiratory Considerations in Cervical Spinal Cord Injury

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

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