Author: Bach, John R.

Source: Journal of Spinal Cord Medicine, Volume 35, Number 2, March 2012 , pp. 72-80(9)

Publisher: Maney Publishing

Abstract:

This article describes noninvasive acute and long-term management of the respiratory muscle paralysis of high spinal cord injury (SCI). This includes full-setting, continuous ventilatory support by noninvasive intermittent positive pressure ventilation (NIV) to support inspiratory muscles and mechanically assisted coughing (MAC) to support inspiratory and expiratory muscles. The NIV and MAC can also be used to extubate or decannulate ‘unweanable’ patients with SCI, to prevent intercurrent respiratory tract infections from developing into pneumonia and acute respiratory failure (ARF), and to eliminate tracheostomy and resort to costly electrophrenic/diaphragm pacing (EPP/DP) for most ventilator users, while permitting glossopharyngeal breathing (GPB) for security in the event of ventilator failure.

Keywords: Respiratory therapy; Electrophrenic pacing; Tetraplegia; Glossopharyngeal breathing; Noninvasive mechanical ventilation; Diaphragm pacing; Mechanical insufflation?exsufflation; Assisted cough; Spinal cord injuries

Document Type: Research Article

DOI: http://dx.doi.org/10.1179/2045772311Y.0000000051

Affiliations: University Hospital, NY, USA

Publication date: 2012-03-01

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