Initial assessment and management of respiratory infections in persons with spinal cord injuries and disorders in the COVID-19 era

JACEP Open, 2020 · DOI: 10.1002/emp2.12282 · Published: September 24, 2020

Simple Explanation

Individuals with SCI/D who develop COVID-19 are at higher risk for rapid decompensation and development of acute respiratory failure during respiratory infections due to the combination of chronic respiratory muscle paralysis and autonomic dysregulation causing neurogenic restrictive/obstructive lung disease and chronic immune dysfunction. Often, acute respiratory infections will lead to significant mucus production in individuals with SCI/D, and aggressive secretion management is an important component of successful medical treatment. ED professionals, including respiratory therapists, should be familiar with the significant comorbidities associated with SCI/D and the customized secretion management procedures and techniques required for optimal medical management and prevention of respiratory failure.

Study Duration

Not specified

Participants

Data from 140 veterans with SCI/D out of a registry of 17,452

Evidence Level

Review Article

Key Findings

1
Persons with SCI/D have greater mortality from pneumonia and influenza compared to the general population with the standardized mortality ratio for pneumonia and influenza for all types of SCI/D calculated approximately 40.2,3
2
The case-fatality rate of 19% for veterans with SCI/D was 2.4 times that of 7.7% in non-SCI/D veterans.
3
Common presenting symptoms include prolonged fever with varying severity that does not improve with antibiotics, dry cough, fatigue/weakness, dyspnea, increased expectoration, diarrhea, and anosmia.

Research Summary

Individuals with SCI/D are at much higher risk of complications of respiratory infections including the more rapid onset of respiratory failure and death due to respiratory muscle paralysis, other chronic respiratory or cardiac conditions, and chronic immune dysfunction. When necessary, aggressive secretion management techniques and a low threshold for transfer to a higher level of care are warranted. The secretion management techniques described above will likely be required for individuals with high thoracic or cervical SCI/D.

Practical Implications

Enhanced Respiratory Care Protocols

Hospitals should implement specific respiratory care protocols for SCI/D patients, including secretion management techniques and early intervention strategies.

Staff Training

Training programs for emergency department and respiratory therapy staff should focus on the unique respiratory needs and management of SCI/D patients, particularly in the context of COVID-19.

Early Hospitalization

A low threshold for early hospitalization should be considered for SCI/D patients presenting with respiratory symptoms, especially those with high tetraplegia or long-term SCI/D.

Study Limitations

1
The epidemiology of COVID-19 in persons with SCI/D is incompletely understood but appears to be similar to the general population
2
Much of the published information on COVID-19 presentation in persons with SCI/D comes from European SCI specialty and rehabilitation centers.
3
The majority of the SCI patients had incomplete injuries in this study and may not be representative of the entire SCI/D population.

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