![]() ![]() 10 For individuals with motor incomplete cervical injuries and lower (C5 and caudal) motor complete SCI, spontaneous respiratory effort may initially be supported by noninvasive bi-level positive airway pressure ventilation (BiPAP), incentive spirometry, positive end-expiratory pressure (PEEP) therapy, vibratory therapy, or lung expansion therapies. Unfortunately, this may lead to atelectasis, increased secretions, hypercapnea, pneumonias, bronchoscopies, a higher FiO 2 requirement, reintubations, inability to vocalize via minimum leak technique or the use of a speaking valve, immobility, and unsuccessful weaning from the ventilator. 10įacilities not familiar with the respiratory impairments of individuals with cervical SCI may manage these individuals in the same manner as they would an individual with non-neuromuscular injuries. 8, 9 Aggressive respiratory therapy interventions need to begin immediately after injury, which is further described in detail below. Because the cough flow and effectiveness are greatly reduced with a cervical SCI, the ability to clear secretions is profoundly affected. 6, 7 Therefore, interventions to aid secretion mobilization are crucial in preventing mucus plugging, atelectasis, pneumonia, and ventilatory failure following injury. The lungs in individuals with acute complete cervical SCI have decreased lung expansion, a highly impaired cough due to the weakness of expiratory muscles, impairment of the elastic recoil of the diaphragm and lung, increased secretion production due to an unopposed parasympathetic stimulation, and decreased surfactant production. 3, 5 Individuals without neurological injuries have an intact cough that is critical for secretion mobilization and expulsion, and surfactant production is present. 3, 4 Secretion and ventilation management of individuals with acute cervical SCI differs greatly from that required by individuals with pulmonary dysfunction secondary to non-neurological injuries. 2 Specialized interventions utilized by respiratory care practitioners in dedicated SCI units have been shown to effectively improve the respiratory status of patients transferred from facilities that do not specialize in SCI care. Individuals with an AIS A SCI and those with high cervical injuries are at higher risk for respiratory complications. In individuals with SCI who have neurological levels of C3 and caudal who are able to spontaneously breathe initially, ventilator failure can occur 4.5 ± 1.2 days after injury and last for an average of 5 weeks. ![]() 1 There is a direct correlation between the level of injury diagnosed between the American Spinal Injury Association (ASIA) Impairment Scale (AIS) and the development of respiratory complications. 1 Atelectasis (36.4%), pneumonia (31.4%), and ventilatory failure (22.6%) are the most common respiratory issues for this group during the acute phase. In the acute hospitalization phase, respiratory complications are prevalent, affecting 84% of persons with C1 to C4 SCI. Respiratory complications are the leading cause of morbidity in individuals with cervical spinal cord injury (SCI), therefore specialized respiratory management is critical after injury.
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