Electrophrenic pacing and decannulation for high-level spinal cord injury: A case series

This paper discusses managing ventilator-dependent patients with high spinal cord injuries who have little to no ability to breathe on their own. The authors outline patient categories, decannulation guidelines, and success in removing tracheostomy tubes from four patients who had no ventilator-free breathing ability and used electrophrenic/diaphragm pacing. The study highlights that the absence of ventilator-free breathing ability in high-level spinal cord injury patients should not automatically lead to tracheostomy or electrophrenic/diaphragm pacing. Patients with some bulbar muscle function can be decannulated to NVS. The case studies show successful decannulation by adhering to specific criteria, including alertness, cooperative nature, sufficient oxyhemoglobin saturation, and effective manually assisted cough. These patients were then managed with non-invasive ventilation.

• 1
  Patients with high-level spinal cord injuries and no ventilator-free breathing ability can be successfully decannulated using specific criteria and managed with noninvasive ventilation.
• 2
  Electrophrenic/diaphragm pacing can facilitate decannulation in patients with no ventilator-free breathing ability or ability to grab a mouthpiece for NVS.
• 3
  Following decannulation, patients can improve their vital capacity and respiratory function through the use of accessory muscles, glossopharyngeal breathing, and air stacking.