Respiratory Complications and Management of Spinal Cord Injuries

Mansel, J. Keith; Norman, Joe R.

doi:10.1378/chest.97.6.1446

Cited by 143 publications

(83 citation statements)

References 36 publications

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“…1 These patients' respiratory capabilities remain nevertheless quite poor, FVC was less than 30% of the expected value, absolute values a little over 1 litre which is similar to observations presented by Mansel and Norman. 11 The remaining nine patients had a lower cervical cord injury and their respiratory capacities were about double that of the other four patients, con®rming the assertion of Kelly and Luce 1 that the higher the level of the spinal cord lesion, the more profound the respiratory failure. The respiratory capacities of the latter patients are in accordance with that measured by Ledsome and Sharp 12 who reported an increase in the vital capacity of a group of tetraplegics from 1.5 litres at the time of hospital admission to 2.7 litres 18 weeks later.…”

Section: Discussionmentioning

confidence: 64%

Effects of respiratory muscle training and electrical stimulation of abdominal muscles on respiratory capabilities in tetraplegic patients

et al. 1997

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Thirteen tetraplegic patients were included in the study of the e ects of respiratory muscle training and of electrical stimulation of the abdominal muscles on their respiratory capabilities. Each patient was subjected for three 1 month lasting periods of the study: for inspiratory muscle training, expiratory muscle training and for a period without training. The sequence of these three periods was random for each patient. Respiratory tests (RT) measuring forced vital capacity (FVC) and forced expiratory volume in one second (FEV 1 ) were conducted before and following each monthly period. Measurements were taken under four sets of conditions: the patients' unassisted e orts, their e orts combined with pressure manually applied by a therapist to the upper part of their abdomen, and their e orts accompanied by electrical stimulation (ES) of the abdominal muscles during the early phase of expirium, once triggered by the therapist and once by the patients themselves. RT values were increased following respiratory muscle training and inspiratory training apparently had a slightly greater e ect than its expiratory counterpart. The increments of values of RT were statistically signi®cant (P50.05) after the inspiratory muscle training. RT measurements were greater when the patient's voluntary e ort was combined with ES of abdominal muscles than when it was not. This study concludes that respiratory muscle training is a potentially e ective approach and that ES of the abdominal muscles has potentials to improve coughing in tetraplegic patients.

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Section: Discussionmentioning

confidence: 64%

Effects of respiratory muscle training and electrical stimulation of abdominal muscles on respiratory capabilities in tetraplegic patients

et al. 1997

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“…3 The number of respiratory complications during this acute phase contributes significantly to both hospital length of stay and costs. 4 In addition to muscle paralysis, a period of spinal shock occurs immediately after a traumatic cervical SCI, resulting in flaccid paralysis of muscles below the level of the cord injury 5,6 that can last from a period of 4 weeks 7 up to several months. 6 The severity of spinal shock is related to the severity of the injury and is correlated with the incidence of respiratory complications.…”

Section: Introductionmentioning

confidence: 99%

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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“…The high frequency of respiratory complications in patients with spinal cord lesions, especially those with tetraplegia, 1 clearly contributes to their morbidity and mortality rates. 2,3 The most important pulmonary function change is a nonparenchymatous pulmonary restriction, 4,5 owing to weakness or paralysis of respiratory muscles.…”

Section: Introductionmentioning

confidence: 99%

Maximal static mouth respiratory pressure in spinal cord injured patients: correlation with motor level

2006

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Study design: Transversal. Objectives: The few studies concerning maximal static mouth respiratory pressures in patients with spinal cord lesions suggest a marked reduction. We studied the correlation of these parameters with the motor level of injury. Setting: Rehabilitation Center, Brası´lia/DF, Brazil. Methods: One hundred and thirty-one patients with traumatic spinal cord injury (C4-L3) were recruited. The participants were assessed by standard spirometry and maximal static mouth respiratory pressure. Results: Forced vital capacity was most reduced in tetraplegics (subgroup C4-C5, 49%725 predicted) and increase successively for each descending subgroup (C6-C8, 61%722 predicted; T1-T6, 70%715 predicted), becoming normal in low paraplegia (T7-L3, 84%715 predicted). There is no evidence of an obstructive disturbance throughout all groups. The lowest average percent predicted of maximal static inspiratory pressure (MIP) was in the subgroup C4-C5 (50%723). The average percent predicted of maximal static expiratory pressure (MEP) improved from 19%714 in the C4-C5 subgroup to 51%719 for T7-L3 subgroup. The average percent predicted of all participants for MIP was 74%730 and for MEP was 37%721. In patients with complete motor lesion, the correlation with the level of injury was stronger for MEP (r ¼ 0.81, Po0.0001; r 2 ¼ 0.65) than for MIP (r ¼ 0.62, P ¼ 0.004; r 2 ¼ 0.38). No correlation was found among incomplete motor lesion patients. Conclusions: The linear regression equations for the relationship of percent predicted MIP or MEP to level of injury are applicable only to complete motor lesions and may be useful to establish normative association between them.

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Respiratory Complications and Management of Spinal Cord Injuries

Cited by 143 publications

References 36 publications

Effects of respiratory muscle training and electrical stimulation of abdominal muscles on respiratory capabilities in tetraplegic patients

Effects of respiratory muscle training and electrical stimulation of abdominal muscles on respiratory capabilities in tetraplegic patients

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

Maximal static mouth respiratory pressure in spinal cord injured patients: correlation with motor level

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