Respiratory Management During the First Five Days After Spinal Cord Injury

Abstract Summary: Respiratory complications are the most common cause of morbidity and mortality in acute spinal cord injury (SCI), with an incidence of 36% to 83%. Eighty percent of deaths in patients hospitalized with cervical SCI are secondary to pulmonary dysfunction, with pneumonia the cause in 50% of the cases. The number of respiratory complications during the acute hospital stay contributes significantly to the length of hospital stay and cost. Four factors (use of mechanical ventilation, pneumonia, the need for surgery, and use of tracheostomy) explain nearly 60% of hospital costs and may be as important a predictor of hospital cost as level of injury. Atelectasis (36.4%), pneumonia (31.4%), and ventilatory failure (22.6%) are the most common complications during the first 5 days after injury. Ventilatory failure occurs on average 4.5 days after injury. Transfer to an SCI center specializing in acute management of tetraplegia has been shown to significantly reduce the number of respiratory complications. This review concentrates on the first 5 days after injury, focusing on complications, predictive factors, prevention, and management of those complications.

[1]  G. Whiteneck,et al.  The effect of tidal volumes on the time to wean persons with high tetraplegia from ventilators , 1999, Spinal Cord.

[2]  A. Sharan,et al.  Tracheostomy placement in patients with complete cervical spinal cord injuries: American Spinal Injury Association Grade A. , 2004, Journal of neurosurgery.

[3]  J. Forner,et al.  The flow-volume loop in tetraplegics , 1977, Paraplegia.

[4]  P. Westbrook,et al.  Pulmonary dysfunction following traumatic quadriplegia. Recognition, prevention, and treatment. , 1980, JAMA.

[5]  P. Macklem,et al.  Aminophylline improves diaphragmatic contractility. , 1981, The New England journal of medicine.

[6]  F C Wagner,et al.  ▪ Respiratory Complications After Cervical Spinal Cord Injury , 1994, Spine.

[7]  R. Bode,et al.  Medical complications during acute rehabilitation following spinal cord injury--current experience of the Model Systems. , 1999, Archives of physical medicine and rehabilitation.

[8]  R. Bellamy,et al.  Respiratory complications in traumatic quadriplegia. Analysis of 20 years' experience. , 1973, Journal of neurosurgery.

[9]  P. Ball.  Critical Care of Spinal Cord Injury , 2001, Spine.

[10]  J. R. Ledsome,et al.  Pulmonary function in acute cervical cord injury. , 1981, The American review of respiratory disease.

[11]  P. Reilly,et al.  Respiratory complications and mortality risk associated with thoracic spine injury. , 2004, The Journal of trauma.

[12]  G. Reisz,et al.  Theophylline and diaphragmatic contractility. Investigation of a dose-response relationship. , 1988, American Review of Respiratory Disease.

[13]  R. Waters,et al.  Emergency, acute, and surgical management of spine trauma. , 1999, Archives of physical medicine and rehabilitation.

[14]  J. Bach.  Alternative methods of ventilatory support for the patient with ventilatory failure due to spinal cord injury. , 1991, The Journal of the American Paraplegia Society.

[15]  J. Kiwerski.  Respiratory problems in patients with high lesion quadriplegia. , 1992, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[16]  C. Winslow,et al.  Impact of respiratory complications on length of stay and hospital costs in acute cervical spine injury. , 2002, Chest.

[17]  R. S. Slack,et al.  Respiratory dysfunction associated with traumatic injury to the central nervous system. , 1994, Clinics in chest medicine.

[18]  S. Kirshblum,et al.  Duplex ultrasound screening for deep vein thrombosis in spinal cord injured patients at rehabilitation admission. , 1999, Archives of physical medicine and rehabilitation.

[19]  D. Schoenfeld,et al.  Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. , 2000, The New England journal of medicine.

[20]  A. Jackson,et al.  Incidence of respiratory complications following spinal cord injury. , 1994, Archives of physical medicine and rehabilitation.

[21]  R. Carter.  Respiratory aspects of spinal cord injury management , 1987, Paraplegia.

[22]  M. Devivo,et al.  Cause of death for patients with spinal cord injuries. , 1989, Archives of internal medicine.

[23]  D. Grundy,et al.  The use of the BiPAP® biphasic positive airway pressure system in acute spinal cord injury , 1998, Spinal Cord.

[24]  R. Marino,et al.  Atelectasis and pneumonia in acute spinal cord injury. , 1990, Archives of physical medicine and rehabilitation.

[25]  Erica R H Sutton,et al.  Characterizing the need for mechanical ventilation following cervical spinal cord injury with neurologic deficit. , 2005, The Journal of trauma.

[26]  C. Winslow,et al.  Effect of spinal cord injury on the respiratory system. , 2003, American journal of physical medicine & rehabilitation.

[27]  N. Cook.  Respiratory care in spinal cord injury with associated traumatic brain injury: bridging the gap in critical care nursing interventions. , 2003, Intensive & critical care nursing.

[28]  M. Badr,et al.  Effects of Theophylline on Pulmonary Function in Patients With Traumatic Tetraplegia , 2006, The journal of spinal cord medicine.

[29]  J. Bach,et al.  Mechanical Insufflation-Exsufflation: Pressure, Volume, and Flow Relationships and the Adequacy of the Manufacturer’s Guidelines , 2002, American journal of physical medicine & rehabilitation.

[30]  K. Bhaskar,et al.  Bronchial mucus hypersecretion in acute quadriplegia. Macromolecular yields and glycoconjugate composition. , 1991, The American review of respiratory disease.

[31]  M. Hayes,et al.  Guidelines for routine respiratory care of patients with spinal cord injury. A clinical report. , 1986, Physical therapy.

[32]  Munehito Yoshida,et al.  Early Complications of High-Dose Methylprednisolone Sodium Succinate Treatment in the Follow-Up of Acute Cervical Spinal Cord Injury , 2001, Spine.

[33]  H. Reines,et al.  Pulmonary complications of acute spinal cord injuries. , 1987 .

[34]  M. Mirski,et al.  Critical Care and Perioperative Management in Traumatic Spinal Cord Injury , 2003, Journal of neurosurgical anesthesiology.

[35]  K. Nantwi,et al.  Adenosinergic mechanisms underlying recovery of diaphragm motor function following upper cervical spinal cord injury: potential therapeutic implications , 2005, Neurological research.

[36]  A. Spungen,et al.  Treatment with an anabolic agent is associated with improvement in respiratory function in persons with tetraplegia: a pilot study. , 1999, The Mount Sinai journal of medicine, New York.

[37]  M. Fehlings,et al.  Predictors of hospital mortality and mechanical ventilation in patients with cervical spinal cord injury , 1998 .

[38]  P. Almenoff,et al.  Bronchodilatory effects of ipratropium bromide in patients with tetraplegia , 1995, Paraplegia.

[39]  I. Lanig,et al.  The respiratory system in spinal cord injury. , 1992, Physical medicine and rehabilitation clinics of North America.