Clinical introduction and benefits of non-invasive ventilation for above C3 cervical spinal cord injury

The Journal of Spinal Cord Medicine, 2021 · DOI: 10.1080/10790268.2019.1644474 · Published: January 1, 2021

Spinal Cord Injury Pulmonology Rehabilitation

Simple Explanation

Patients with high cervical spinal cord injuries often need long-term ventilator support. This study explores switching these patients from tracheostomy ventilation to non-invasive ventilation (NIV). The study aimed to find the best time to introduce NIV, how well it works, and any long-term complications. They looked at patients who were switched to NIV and followed up on their health and social status. The results showed that switching to NIV was more successful when done within one year of the injury. It also improved breathing capacity for some patients and allowed many to live at home in the community.

Study Duration

2005-2010 (referral period) with follow-up ranging from 11 to 71 months

Participants

14 tracheostomy ventilator-dependent patients with above C3 spinal lesions and ASIA A

Evidence Level

Retrospective study

Key Findings

1
Switching to NIV was more successful when implemented within one year of the spinal cord injury.
2
NIV improved vital capacity in C2 ASIA A and C1 ASIA A patients who had adequate respiratory accessory muscle strength to expand the chest wall.
3
All patients who were successfully switched to NIV lived in the community.

Research Summary

This retrospective study investigated the clinical introduction and benefits of non-invasive ventilation (NIV) for patients with high-level cervical spinal cord injuries (CSCI). The study aimed to determine the optimal timing for NIV introduction, assess its clinical effectiveness, and identify any long-term complications. The study found that switching to NIV within one year of the injury was significantly more successful. Furthermore, NIV improved respiratory function in certain patient groups and facilitated ventilator-free breathing. Most patients successfully transitioned to NIV and were able to live in the community. The authors concluded that ventilator-dependent patients should be switched to NIV within one year of injury, as long-term NIV can improve respiratory function and clinical outcome.

Practical Implications

Early NIV Adoption

Clinicians should consider introducing NIV within the first year post-injury for ventilator-dependent patients with high-level CSCI.

Respiratory Function Improvement

NIV can potentially improve respiratory function, particularly in patients with sufficient respiratory accessory muscle strength.

Enhanced Quality of Life

Successful transition to NIV can enable patients to live in the community and improve their overall quality of life.

Study Limitations

1
The strength of respiratory accessory muscles was not measured by EMG using surface electrodes.
2
The sample size was not sufficient enough to determine the factors responsible for failure of switching to NIV.
3
The study did not include a control group of subjects who were maintained on intubation to allow better assessment of the effects of NIV with tracheostomized ventilation.

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