“…Individuals with acute complete tetraplegia are particularly vulnerable to respiratory failure during the acute phase resulting from the combined effect of spinal shock leading to flaccid chest wall muscles, denervation of the ventilatory muscles, presence of concomitant lung injuries, potential decreased respiratory drive due to concomitant head injuries and narcotic analgesic, and cervical soft tissue edema associated with the surgery [5]. Between 40 and 80% of subjects with acute complete tetraplegia may therefore require mechanical ventilation (MV) support during the acute care [6][7][8]. As prolonged oral/nasal endotracheal tubes is detrimental, tracheostomy placement is required in 10-60% of patients following tetraplegia [6,9,10].…”