Respiratory Dysfunction and Management in Spinal Cord Injury

Respir Care, 2006 · DOI: · Published: August 1, 2006

Simple Explanation

Spinal cord injury (SCI) often leads to respiratory problems because it weakens the muscles needed for breathing and coughing. This can reduce lung capacity and make it harder to clear secretions, increasing the risk of infections. People with SCI may need help from ventilators to breathe. However, advances like phrenic nerve pacing (stimulating the diaphragm) and training respiratory muscles can help some people breathe on their own. For those on ventilators, special adjustments can improve their speech quality. Also, techniques like abdominal binders and assisted cough methods can help clear secretions and improve breathing.

Study Duration

Not specified

Participants

361 men with chronic SCI in prospective mortality study; 278 individuals with chronic SCI tested for spirometry standards

Evidence Level

Review Article

Key Findings

1
Independent predictors of all-cause mortality in SCI include diabetes mellitus, heart disease, cigarette smoking, and percent-of-predicted forced expiratory volume in the first second.
2
Respiratory muscle training improves vital capacity (VC) and can enhance respiratory muscle performance in tetraplegics.
3
Combining prolonged inspiratory time and positive end-expiratory pressure (PEEP) can significantly improve speech quality for tracheostomy-ventilated patients.

Research Summary

Respiratory dysfunction is a major cause of morbidity and mortality in SCI. In the last several decades, much has been learned about the mechanisms of respiratory dysfunction, and this has led to useful interventions. Respiratory-muscle training improves VC. A multicenter effort to assess the effect of respiratory-muscle training on problems such as dyspnea and weak cough is warranted. Respiratory-muscle pacing has shown promise in liberating patients from mechanical ventilation and in improving cough. Noninvasive methods to provide assisted ventilation are also effective, yet underutilized. With further research, there will perhaps be enough progress to substantially reduce the morbidity and mortality from respiratory dysfunction in SCI.

Practical Implications

Improved Respiratory Care

Implement respiratory muscle training programs to enhance vital capacity and respiratory muscle performance in SCI patients.

Optimized Ventilator Settings

Adjust ventilator settings (prolonged inspiratory time and PEEP) to improve speech quality in tracheostomy-ventilated patients.

Comprehensive Mortality Risk Assessment

Assess and manage risk factors like diabetes, heart disease, and smoking to reduce mortality in SCI patients.

Study Limitations

1
The best respiratory-muscle training regimen has not been established.
2
Long-term success of exercise programs in SCI is uncertain due to patient motivation challenges.
3
The clinical effectiveness of spinal-cord stimulation to enhance cough needs further investigation.

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