Respiratory management in acute traumatic tetraplegia

Cheshire, D J E

doi:10.1038/sc.1963.22

Cited by 32 publications

(12 citation statements)

References 5 publications

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“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] As a result, most of these patients suffer from a markedly reduced ability to clear airway secretions resulting in the development of atelectasis and recurrent respiratory tract infections. In recent human studies, we demonstrated that an effective cough can be restored in subjects with SCI via stimulation of electrodes positioned on the lower thoracic and upper lumbar spinal cord.…”

Section: Introductionmentioning

confidence: 99%

Comparison of wire and disc leads to activate the expiratory muscles in dogs

Kowalski

DiMarco

2011

The Journal of Spinal Cord Medicine

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Objective: Respiratory complications account for a major cause of morbidity and mortality in subjects with spinal cord injury (SCI) due to paralysis of the expiratory muscles and the consequent inability to generate effective cough. We demonstrated previously that effective cough can be restored in SCI via spinal cord stimulation (SCS) with disc leads positioned on the lower thoracic and upper lumbar spinal cord via laminotomy incisions. In this study, the effectiveness of wire leads, which can be placed using minimally invasive techniques, to activate the expiratory muscles was evaluated. Design: Animal study. Setting: Research laboratory. Animals: Dogs (n = 8).Interventions: In separate trials, disc and wire leads were inserted onto the dorsal epidural space at the T9, T11, and L1 spinal cord levels. Effects of electrical stimulation with disc, single wire, and two wire leads placed in parallel were compared. Outcome measures: Airway pressure generation following stimulation with disc and various configurations of wire leads were compared. Results: Several different configurations of wire leads resulted in airway pressures that were similar to those generated with monopolar stimulation with disc leads (MSDLs). For example, combined monopolar stimulation with parallel wire leads at the T9 + T11 and T9 + L1 levels resulted in airway pressures that were 103.5 ± 6.4 and 101.9 ± 7.0%, respectively, of those achieved with MSDL. Bipolar stimulation with parallel wire leads at T9-T11 and T9-L1 resulted in airway pressures that were 94.2 ± 3.4 and 96.8 ± 5.0%, respectively, of the pressures achieved with MSDL. Other wire configurations were also evaluated, but were generally less effective. Conclusion: These results suggest that specific configurations of wire leads, which can be placed via minimally invasive techniques, result in comparable activation of the expiratory muscles compared to disc leads and may be a useful technique to restore cough in persons with SCI.

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Section: Introductionmentioning

confidence: 99%

Comparison of wire and disc leads to activate the expiratory muscles in dogs

Kowalski

DiMarco

2011

The Journal of Spinal Cord Medicine

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“…The diaphragm, that is the main inspiratory muscle, is spared in lesions below C5 but at this level all expiratory muscles are paralysed. This has very deleterious effects on the ventilatory function of the lungs, especially in the early stages when the mortality rate, due to respiratory problems, is very high, ranging from 7'4 to 40 per cent (Durbin, 1957;Norton, 1962;Tribe, 1963;Cheshire, 1964;Cheshire & Coats, 1966;Guttmann & Frankel, 1966;Silver & Gibbon, 1968;Bellamy et at., 1973).…”

Section: Introductionmentioning

confidence: 99%

Lung volumes and mechanics of breathing in tetraplegics

Forner

1980

Spinal Cord

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Abstract. The purpose of this study was to investigate the influence of the paralysis of some respiratory muscles, due to a spinal cord lesion, on the lung volumes and the mechanics of breathing, specially on the maximal expiratory flows. Fifty-two tetraplegics have been studied, divided in two groups-according to the level of the lesion to investi gate if there is any difference in the behaviour of both groups.

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“…It is well known that the respiratory problems are the most important cause of death in the early stages of tetraplegics (Durbin, 1957;Norton, 1962;Tribe, 1963;Cheshire, 1964).…”

Section: Introductionmentioning

confidence: 99%

The flow-volume loop in tetraplegics

1977

Spinal Cord

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Respiratory management in acute traumatic tetraplegia

Cited by 32 publications

References 5 publications

Comparison of wire and disc leads to activate the expiratory muscles in dogs

Comparison of wire and disc leads to activate the expiratory muscles in dogs

Lung volumes and mechanics of breathing in tetraplegics

The flow-volume loop in tetraplegics

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