Effect of Spinal Cord Injury on the Respiratory System

Winslow, Christopher; Rozovsky, Julia

doi:10.1097/01.phm.0000078184.08835.01

Cited by 243 publications

(192 citation statements)

References 60 publications

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“…47 It was decided to include these papers as these data are referred to in recent narrative reviews and form the basis of current treatment recommendations. 48,49 In conclusion, this systematic review has revealed that a clinical pathway with a structured respiratory protocol that includes a combination of treatment techniques provided regularly is effective in reducing respiratory complications and the cost of acute care. Future consideration of collaboration and trial design with particular emphasis on inclusion criteria especially neurological severity and injury is necessary so trials of sufficient quality and power are performed that address effective ways of improving overall pulmonary function and performance and the prevention of respiratory complications.…”

Section: Discussionmentioning

confidence: 90%

The acute respiratory management of cervical spinal cord injury in the first 6 weeks after injury: a systematic review

et al. 2010

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Study design: Systematic review. Objectives: Identify, evaluate, and synthesize evidence regarding the effectiveness of various treatment strategies for the respiratory management of acute tetraplegia. Setting: Melbourne, Australia. Methods: A search of multiple electronic databases (Medline, Cinahl, EMBASE, Cochrane Library, Web of Science, http://www.guideline.gov and http://www.icord.org/scire) was undertaken accompanied by the reference lists of all relevant articles identified. Methodological quality was assessed using the Newcastle-Ottawa Scale and the PEDro Scale. Descriptive analysis was performed. Results: Twenty-one studies including 1263 patients were identified. The majority of the studies were case series (n ¼ 13). A variety of interventions were used for the management of respiratory complications. Mortality (ARR ¼ 0.4, 95% confidence interval (CI) 0.18, 0.61), the incidence of respiratory complications (ARR ¼ 0.36, 95% CI (0.08, 0.58)), and requirement for a tracheostomy (ARR ¼ 0.18, 95% CI (À0.05, 0.4)) were significantly reduced by using a respiratory protocol. A clinical pathway reduced duration of mechanical ventilation by 6 days 95% CI (À0.56, 12.56), intensive care unit length of stay by 6.8 days 95% CI (0.17-13.77) and costs. Intubation, mechanical ventilation, and tracheostomy are the mainstay of respiratory management for complete injuries above the level of C5. Conclusion: This review showed a clinical pathway with a structured respiratory protocol that includes a combination of treatment techniques provided regularly is effective in reducing respiratory complications and cost. The overall study quality was moderate and further studies using specific interventions that target respiratory complications are associated with specific regions of the cervical spine using more methodologically rigorous designs are required.

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Section: Discussionmentioning

confidence: 90%

The acute respiratory management of cervical spinal cord injury in the first 6 weeks after injury: a systematic review

et al. 2010

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“…Approximately one half of spinal cord injuries occur in the cervical region (Winslow and Rozovsky, 2003) which with rare exception produce some degree of respiratory insufficiency and related complications -the severity of which correlates with the specific cervical spinal level of the injury (Winslow and Rozovsky, 2003). Although clinically relevant in cases of asymmetric (i.e., lateralized) high cervical contusion injuries, C2HS primarily provides a proof-of-principle model for respiratory resiliency in the phrenic motor system.…”

Section: Discussionmentioning

confidence: 99%

Modest spontaneous recovery of ventilation following chronic high cervical hemisection in rats

Fuller

Doperalski

Dougherty

et al. 2008

Experimental Neurology

116

167

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Following C2 spinal hemisection (C2HS) in adult rats, ipsilateral phrenic motoneuron (PhMN) recovery occurs through a time-dependent activation of latent, crossed-spinal collaterals (i.e., spontaneous crossed phrenic phenomenon; sCPP) from contralateral bulbospinal axons. Ventilation is maintained during quiet breathing after C2HS, but the ability to increase ventilation during a respiratory stimulation (e.g. hypercapnia) is impaired. We hypothesized that long-term expression of the sCPP would correspond to a progressive normalization in ventilatory patterns during respiratory challenge. Breathing was assessed via plethsymography in unanesthetized animals and phrenic motor output was measured in urethane-anesthetized, paralyzed and vagotomized rats. At 2-week post-C2HS, minute ventilation (VE) was maintained during baseline (room air) conditions as expected but was substantially blunted during hypercapnic challenge (68±3% of VE in uninjured, weight-matched rats). However, by 12 weeks the spinal-lesioned rats achieved a hypercapnic VE response that was 85±7% of control (p = 0.017 vs. 2 wks). These rats also exhibited augmented breaths (AB's) or "sighs" more frequently (p<0.05) than controls; however, total AB volume was significantly less than control at 2-and 12-week post-injury (69±4% and 80±5%, p<0.05, respectively). We also noted that phrenic neurograms demonstrated a consistent delay in onset of the ipsilateral vs. contralateral inspiratory phrenic burst at 2-12-week post-injury. Finally, the ipsilateral phrenic response to respiratory challenge (hypoxia) was greater, though not normalized, at 4-12-vs. 2-week post-injury. We conclude that recovery of ventilation deficits occurs over 2-12-week post-C2HS; however, intrinsic neuroplasticity remains insufficient to concurrently restore a normal level of ipsilateral phrenic output.

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“…There all contribute to a reduction in the tangential tension developed by the diaphragm according to La Place's law, and eventually cause a reduction in the VC. 29 For a cough to be effective, three actions of a normal cough (inspiration, compression, and expulsion) should properly be operated. 12 In the inspiration phase, normal subjects increase the precough tidal volumes to approximately 85-90% of their inspiratory capacity and have a total cough volume of 2.370.5 l so as to obtain the optimal PCFs.…”

Section: Discussionmentioning

confidence: 99%

Relationship between inspiratory muscle strength and cough capacity in cervical spinal cord injured patients

Kang

Shin

et al. 2005

Spinal Cord

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Study design: Prospective single centre study. Objectives: Pulmonary rehabilitation focuses on improving the expiratory muscle function in order to increase the reduced cough capacity in patients with cervical spinal cord injuries (SCI). However, an improvement in the inspiratory function is also important for coughing effectively. Therefore, this study was to examine the significance of the inspiratory muscle strength on the cough capacity in the patients with a cervical SCI. Setting: SCI unit, Yonsei Rehabilitation Hospital, Seoul, Korea. Methods: The vital capacity (VC), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP) were measured. Moreover, the unassisted peak cough flow (PCF) and assisted PCF under three conditions were evaluated. Results: All three assisted cough methods showed a significantly higher value than the unassisted method (Po0.001). The VC correlated with the voluntary cough capacity and the MIP (R ¼ 0.749) correlated more significantly with the VC than the MEP (R ¼ 0.438) (Po0.01). The MIP showed a higher correlation with both the unassisted PCF and all three assisted PCFs than the MEP (Po0.001). Conclusions: The management of the inspiratory muscle strength should be considered in the pulmonary rehabilitation at cervical SCI patients.

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Effect of Spinal Cord Injury on the Respiratory System

Cited by 243 publications

References 60 publications

The acute respiratory management of cervical spinal cord injury in the first 6 weeks after injury: a systematic review

The acute respiratory management of cervical spinal cord injury in the first 6 weeks after injury: a systematic review

Modest spontaneous recovery of ventilation following chronic high cervical hemisection in rats

Relationship between inspiratory muscle strength and cough capacity in cervical spinal cord injured patients

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