Noninvasive Options for Ventilatory Support of the Traumatic High Level Quadriplegic Patient

Bach, John R.; Alba, Augusta

doi:10.1378/chest.98.3.613

Cited by 158 publications

(101 citation statements)

References 23 publications

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“…10 In patients with DMD, Kang and Bach 9 and Ishikawa et al 8 concluded that it is necessary to produce high intrathoracic pressures to obtain an efficient cough when the expiratory muscles are weak by using manual methods that increase the ability to cough. Their results have supported those observed by Bach and Alba,19 who demonstrated the effectiveness of manually assisted cough in patients with high SCI. The results obtained in our study are consistent with the authors mentioned above, who described that during the assisted cough, the PCF increases significantly compared with the MEE.…”

Section: Discussionsupporting

confidence: 88%

“…Bach and Alba's research was performed in subjects with non-invasive ventilation dependence, who traditionally receive advanced respiratory care and have a restrictive respiratory pattern. 19 We propose an early intervention in patients with an evolution of o1 year, given that in the long term, these subjects will have a restrictive respiratory pattern, and the AS with AC technique appears to be an effective alternative to assist cough preventing lung complications and decrease respiratory morbidity.…”

Section: Discussionmentioning

confidence: 99%

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Use of air stacking and abdominal compression for cough assistance in people with complete tetraplegia

et al. 2014

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Study design: Cross-sectional. Objective: To assess cough using air stacking (AS) to assist inspiratory volume with abdominal compression (AC) during expiration in patients with American Spinal Injury Association Impairment Scale (AIS) A. Setting: Large tertiary hospital in Chile. Methods: Peak cough flow (PCF) was measured during four different interventions: spontaneous maximal expiratory effort (MEE); MEE while receiving AC (MEE-AC); MEE after AS with a manual resuscitation bag (AS-MEE); and MEE with AS and AC (AS-MEE-AC). Results: Fifteen in-patients with complete tetraplegia (C4-C6) were included. Median age was 33 years . PCF during the different interventions was PCF for MEE was 183 ± 90 l min À1 ; PCF for MEE-AC was 273 ± 119 l min À1 ; PCF for AS-MEE was 278 ± 106 l min À1 and PCF for AS-MEE-AC was 368 ± 129 l min À1 . We observed significant differences in PCF while applying MEE-AC and AS-MEE compared with MEE (P ¼ 0.0001). However, the difference in PCF value was greater using the AS-MEE-AC technique (P ¼ 0.00001). Conclusion: Patients with spinal cord injury (SCI) presented an ineffective cough that constitutes a risk factor for developing respiratory complications. The application of combined techniques (AS-MEE-AC) can reach near normal PCF values. This is a lowcost, simple and easily applied intervention that could be introduced to all patients with tetraplegia.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Use of air stacking and abdominal compression for cough assistance in people with complete tetraplegia

et al. 2014

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“…One study reported a population of 31 tetraplegics who regained autonomous breathing function a mean of 2.4+2.2 years (1 month to 8 years) following injury. 26 Another study on pulmonary function in tetraplegics documented a 49% increase in VC in the supine position and 60% increase in the sitting position occurring over a mean period of 7.7 to 11.6 years after injury without any speci®c treatment. 27 This implies that inspiratory muscle strength and possibly the VC's of some patients may be still improving years after injury.…”

Section: Discussionmentioning

confidence: 99%

Vital capacity in tetraplegics twenty years and beyond

2001

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Objectives: To observe the trends in vital capacity (VC) over time in tetraplegics 20 years and more after injury, the e ects of age at injury, severity of injury and gender on this trend. Methods: The medical records of all spinal cord injured persons admitted to a regional spinal injury center from January 1960 to December 1996 were reviewed. Fifty-seven patients had documented post-rehabilitation VC (mean 1.3+1.1 years) and VC at 10 (mean 11.8+2.69) and 20 (20.60+2.67) years post injury and beyond. Results: The mean age at injury was 23.2+9.1 years. Severity of injury when classi®ed according the system proposed by Coll et al were: Group 1: C1 ± 4 Frankel A injury: 11.6%, Group 2: C5 ± 8 Frankel A injury: 55.6%, Group 3: C2 ± 8 Frankel B and C: 29.8% and Group 4: C2 ± 8 Frankel D: 3.5% respectively. The mean VC at initial, 10 and 20 years post injury was 2586+948, 2803+940 and 2525+818 cc respectively. Multivariate analysis of variance revealed that there was signi®cant di erence in VC over a 20 year period, (F(2,54)=8.43, P50.05). The di erence between VC at 10 years and VC at 20 years accounted for the 19.8% of the variance in VC over time (F(1,55)=12.35, P50.05). Age at injury, gender and severity of injury did not have a signi®cant in¯uence on the rate of decline in VC. Analysis of a subset of 26 patients who were followed up more than 20 years post injury (range 22 to 34.5 years) revealed similar,

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“…Individuals with complete tetraplegia at the C3 and C4 neurological levels were selected because they represent a level at which ventilator free breathing is di cult but theoretically possible. 2,5 Individuals with these levels of injury were identi®ed by the presence of functional bilateral trapezius muscle strength (manual muscle test grades of`fair' or better 19 ), and non-functional distal musculature (grade`poor' or less 19 ), including both biceps and deltoids.…”

Section: Methodsmentioning

confidence: 99%

“…The length of time required for them to become ventilator-free can be protracted ± as long as 14 months in one report, 4 up to 8 years in another. 5 During this process (regardless of its duration) rehabilitation and community placement options are limited, and costly equipment and considerably higher levels of nursing, respiratory, and other specialized care are needed.…”

Section: Introductionmentioning

confidence: 99%

The effect of tidal volumes on the time to wean persons with high tetraplegia from ventilators

et al. 1999

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Study design: Retrospective review of patient medical records comparing the outcomes of two groups of individuals with high-level (C3-4) tetraplegia ± those with high-volume and those with low-volume mechanical ventilation. Objectives: To determine if higher volume mechanical ventilation contributes to faster weaning from the ventilator with fewer complications in individuals with ventilator dependent high-level tetraplegia. Setting: A Model Spinal Injury Center, located in Colorado, USA, which treats patients referred from throughout the Rocky Mountain region as well as other states. Methods: The medical records of 42 individuals with ventilator dependent C3-4 tetraplegia, admitted consecutively to the Rocky Mountain Regional Spinal Injury System between 1983 and 1993, were reviewed. All had required full-time mechanical ventilation upon admission, but had successfully weaned by discharge. They were divided into two groups that di ered with respect to the ventilator tidal volumes used during their treatment and weaning: a large volume group (420 mls/kg of body weight) and a smaller volume group (520 mls/kg of body weight). Results: Though the two groups were equivalent in neurological level and completeness, muscular function, initial spontaneous vital capacity, the weaning method used (T-piece), and ®nal spontaneous vital capacity, those in the large tidal volume group successfully weaned an average of 21 days faster than the lower tidal volume group (37.6 days vs 58.7 days, P=0.02). They also had signi®cantly less atelectasis (P=0.01) than the lower tidal volume group. Conclusion: This research suggests that the use of higher ventilator tidal volumes may speed up the weaning process and lessen respiratory complications. Because of the potential for this to decrease the length and cost of the rehabilitation programs for persons with high-level tetraplegia, further large-scale research is needed to verify these single-center ®ndings.

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Noninvasive Options for Ventilatory Support of the Traumatic High Level Quadriplegic Patient

Cited by 158 publications

References 23 publications

Use of air stacking and abdominal compression for cough assistance in people with complete tetraplegia

Use of air stacking and abdominal compression for cough assistance in people with complete tetraplegia

Vital capacity in tetraplegics twenty years and beyond

The effect of tidal volumes on the time to wean persons with high tetraplegia from ventilators

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