Respiratory Complications and Weaning Considerations for Patients with Spinal Cord Injuries: A Narrative Review

Abstract

Respiratory complications following traumatic spinal cord injury are common and are associated with high morbidity and mortality. The inability to cough and clear secretions coupled with weakened respiratory and abdominal muscles commonly leads to respiratory failure, pulmonary edema, and pneumonia. Higher level and severity of the spinal cord injury, history of underlying lung pathology, history of smoking, and poor baseline health status are potential predictors for patients that will experience respiratory complications. For patients who may require prolonged intubation, early tracheostomy has been shown to lead to improved outcomes. Prediction models to aid clinicians with the decision and timing of tracheostomy have been shown to be successful but require larger validation studies in the future. Mechanical ventilation weaning strategies also require further investigation but should focus on a combination of optimizing ventilator setting, pulmonary toilet techniques, psychosocial well-being, and an aggressive bowel regimen.

Tatalaksana ICU pada Pasien Pasca Laminektomi Servikal dengan Kesulitan Weaning dan Ekstubasi

“…3 Studi oleh Claxton et al menunjukkan bahwa kebutuhan akan ventilasi mekanik dapat diprediksi pada cedera medula spinalis segmen C5 dan di atasnya. 10 Harrop dkk. menunjukkan bahwa sebesar 79% kasus cedera medula spinalis komplit yang melibatkan segmen C5 dan di atasnya memerlukan trakeostomi.…”