Good Bronchial Hygiene Reaches the Left Lung: Successful Extubation in a Tetraplegic Patient With Spinal Cord Injury

Cureus, 2022 · DOI: 10.7759/cureus.28732 · Published: September 3, 2022

Spinal Cord Injury Pulmonology Rehabilitation

Simple Explanation

Spinal cord injuries can lead to respiratory complications due to weakened cough and breathing muscles. This can cause mucus buildup and lung problems. Mechanical insufflation-exsufflation (MIE) is a therapy that helps clear lung secretions by increasing airflow in and out of the lungs, mimicking a strong cough. This case report shows how MIE therapy helped a patient with a cervical spinal cord injury and lung infection to improve, allowing them to be removed from a ventilator and transition to non-invasive support.

Study Duration

Not specified

Participants

A 67-year-old cervical SCI patient

Evidence Level

Case Report

Key Findings

1
MIE therapy led to improvement of atelectasis (collapsed lung) in a cervical SCI patient within one day of starting treatment.
2
The patient was successfully extubated six days after starting bronchial hygiene with MIE therapy.
3
The patient safely transitioned to non-invasive ventilatory support (NIV) after extubation, with no need for oxygen support.

Research Summary

This case report describes the successful use of mechanical insufflation-exsufflation (MIE) therapy in a 67-year-old cervical spinal cord injury (SCI) patient with lung infection and atelectasis who was experiencing difficulty weaning from a ventilator. The introduction of MIE therapy resulted in improved clearance of bronchial secretions, partial reversal of atelectasis, and ultimately allowed for successful extubation and transition to non-invasive ventilation. The authors suggest that MIE therapy can be a valuable tool in preparing SCI patients for extubation by facilitating bronchial hygiene and preventing atelectasis, particularly in the left lung.

Practical Implications

Improved Respiratory Management

MIE therapy can be a valuable non-invasive tool for managing bronchial secretions and preventing atelectasis in SCI patients, particularly those with cervical injuries.

Facilitated Ventilator Weaning

MIE therapy may facilitate ventilator weaning and reduce the need for tracheostomy in SCI patients with respiratory complications.

Enhanced Patient Comfort

MIE is reported to be less irritating, painful, tiring, and uncomfortable than endotracheal suctioning, improving the patient experience.

Study Limitations

1
Single case report limits generalizability.
2
Lack of a control group.
3
The effectiveness of MIE may vary depending on the individual patient and the severity of their condition.

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