Noninvasive respiratory management of high level spinal cord injury

The Journal of Spinal Cord Medicine, 2012 · DOI: 10.1179/2045772311Y.0000000051 · Published: January 1, 2012

Simple Explanation

This article focuses on managing breathing problems in people with high spinal cord injuries without surgery. It uses noninvasive methods to help with both inhaling and coughing. The methods described include noninvasive ventilation (NIV) to support the inspiratory muscles and mechanically assisted coughing (MAC) to support both inspiratory and expiratory muscles. These techniques can help patients avoid tracheostomies, prevent respiratory infections from becoming serious, and reduce the need for costly procedures like diaphragm pacing, while also allowing them to use glossopharyngeal breathing.

Study Duration

Not specified

Participants

Over 215 'unweanable' patients with neuromuscular weakness including 19 with SCI

Evidence Level

Invited review

Key Findings

1
Noninvasive methods can support breathing and coughing for SCI patients, reducing the need for tracheostomies.
2
Noninvasive ventilation and mechanically assisted coughing can help 'unweanable' patients with SCI to be extubated or decannulated.
3
Glossopharyngeal breathing can provide a safety net for ventilator-dependent individuals in case of ventilator failure.

Research Summary

This review describes the noninvasive management of respiratory muscle paralysis in high spinal cord injury (SCI), including NIV and MAC. These techniques can be used to extubate or decannulate 'unweanable' patients, prevent respiratory infections, eliminate tracheostomy, and permit glossopharyngeal breathing. The article emphasizes assessing and treating respiratory muscle function rather than focusing solely on lung/airways disease, leading to successful extubation and avoidance of pneumonia.

Practical Implications

Improved Patient Outcomes

Noninvasive respiratory management can improve the quality of life for SCI patients by reducing the need for invasive procedures and promoting independence.

Reduced Healthcare Costs

Avoiding tracheostomies and diaphragm pacing can significantly reduce healthcare costs associated with long-term respiratory support for SCI patients.

Paradigm Shift in Respiratory Care

A new evaluation and management paradigm is needed to focus on respiratory muscle function rather than lung/airway disease in SCI patients.

Study Limitations

1
Bulbar dysfunction causing saliva aspiration necessitates tracheotomy.
2
Patients with traumatic brain injury, chest trauma, or anxiety may require intubation.
3
The review primarily focuses on noninvasive methods and may not cover all possible respiratory management strategies.

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury