Authors' objectives:

This report describes evidence on the respiratory management of persons with acute or chronic cervical level spinal cord injury (SCI), including mechanical ventilation and other interventions aimed at preventing or treating respiratory diseases.

Authors' results and conclusions: Patients with C4-level SCI have greater weaning success using progressive ventilatory-free breathing than synchronized intermittent mandatory ventilation techniques. In addition, high ventilator volume (more than 20 cc/kg) is associated with less atelectasis and faster weaning. Aggressive multimodal respiratory therapy interventions (including frequent turning, suctioning [and bronchial lavage], chest percussion and assisted coughing, inhaled bronchodilator treatments, deep breathing, and incentive spirometry) and rotating beds have been associated with reduced mortality, atelectasis, need for mechanical ventilation, or tracheostomy. Other secretion clearance modalities show evidence of improved cough (manual assisted cough, mechanical insufflator-exsufflator, glossopharyngeal breathing) but include no data on health outcomes. There is little evidence of an effect for other interventions, including active respiratory muscle exercise with incentive spirometry, inspiratory resistance training, and abdominal weight training. Several alternatives to tracheostomy positive pressure ventilation (PPV) for long-term ventilatory support have been demonstrated, including electrophrenic respiration, noninvasive positive pressure ventilation, intermittent positive pressure breathing, pneumobelt, and glossopharyngeal breathing. Noninvasive ventilation may reduce the risk of pneumonia compared with tracheostomy PPV for patients requiring chronic ventilatory support.

Authors' recommendations: Treatments aimed at improving ventilation, cough, and secretion clearance reduce atelectasis, pneumonia and the need for mechanical ventilation. Clinical research studies on pulmonary disease following cervical SCI cover only a small number of many important management decisions. Few studies use control groups (randomized or otherwise) or other designs to reduce bias.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/epcsums/spinalsum.htm

Year Published: 2001

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)