Respiratory Management in the Patient with Spinal Cord Injury

Abstract

Spinal cord injuries (SCIs) often lead to impairment of the respiratory system and, consequently, restrictive respiratory changes. Paresis or paralysis of the respiratory muscles can lead to respiratory insufficiency, which is dependent on the level and completeness of the injury. Respiratory complications include hypoventilation, a reduction in surfactant production, mucus plugging, atelectasis, and pneumonia. Vital capacity (VC) is an indicator of overall pulmonary function; patients with severely impaired VC may require assisted ventilation. It is best to proceed with intubation under controlled circumstances rather than waiting until the condition becomes an emergency. Mechanical ventilation can adversely affect the structure and function of the diaphragm. Early tracheostomy following short orotracheal intubation is probably beneficial in selected patients. Weaning should start as soon as possible, and the best modality is progressive ventilator-free breathing (PVFB). Appropriate candidates can sometimes be freed from mechanical ventilation by electrical stimulation. Respiratory muscle training regimens may improve patients' inspiratory function following a SCI.

Respiratory Training Improves Blood Pressure Regulation in Individuals With Chronic Spinal Cord Injury

“…This finding is consistent with reports of others suggesting that respiratory exercise is effective for improving respiratory function in individuals with SCI during acute 41 and chronic SCI, 42–47 as well as in patients with other disorders. 48–50 However, the approach of reciprocal inspiratory-expiratory training with adjustable load has never been previously used in SCI population.…”

Use of electromyographic signals for characterization of voluntary coughing in humans with and without spinal cord injury—A systematic review

“…In individuals with SCI, biopotentials measured with an oesophageal electrode appeared on the diaphragm in the inspiratory phase. During contraction of this region, expiratory muscles such as the rectus abdominis remain paralysed or with low muscle activity (Galeiras Vázquez, Rascado Sedes, Mourelo Fariña, Montoto Marqués, & Ferreiro Velasco, ). In patients with SCI, the diaphragm moves, causing changes in the abdomen diameter.…”

Atypical presentation of Covid-19 in persons with spinal cord injury

“…We suspect that, rather than cough, fever and shortness of breath (typical presenting symptoms in able-bodied persons), hypoxia (<90% SpO2), a worsened ability to clear secretions and tachypnea may be the initial symptoms in persons with SCI. Treatment of respiratory infections in persons with SCI includes early respiratory therapy involvement with aggressive pulmonary toilet including manually assisted coughing, mechanical assisted coughing (insufflation-exsufflation), chest percussion, vibrations and postural drainage [7]. Note that caution should be used with cough assist and manually assisted coughing to avoid exposure to aerosolized secretions, by ensuring appropriate PPE are worn.…”