Noninvasive Options for Ventilatory Support of the Traumatic High Level Quadriplegic Patient

doi:10.1378/chest.98.3.613

Chest

Volume 98, Issue 3, September 1990, Pages 613-619

https://doi.org/10.1378/chest.98.3.613 Get rights and content

The ventilation of 25 ventilator-dependent traumatic quadriplegic patients was supported by noninvasive means of ventilatory assistance. Twenty-four of the 25 were initially managed by endotracheal intubation, and 23 of these went on to tracheostomy intermittent positive pressure ventilation before being converted to NVA. Seventeen of the 23 patients had their tracheostomies closed. This included three patients with no significant free time except with the use of glossopharyngeal breathing. Seven of the 25 patients who used NVA for at least one year with no significant free time have employed NVA for a mean of 7.4 ±7.4 years (1 to 22 years). Mouth IPPV was the most common form of NVA used both during the daytime and overnight. The wrap ventilators, intermittent abdominal pressure ventilator, and GPB were also employed for long-term respiratory support. It was concluded that, in general, because of their youth, intact mental status and bulbar musculature, and absence of obstructive lung disease, patients with traumatic high level spinal cord injury are candidates to benefit from these techniques.

Section snippets

PATIENTS AND METHODS

Eighty ventilator-dependent traumatic quadriplegic patients including 64 male and 16 female patients with a mean age of 21.9 ±5 years at the time of injury were admitted for management of ventilator dependence and pulmonary rehabilitation from 1965 to the present. Seventy-eight of these patients had been managed by intubation and 77 by tracheostomy at some time following their acute injuries. Four of the patients presented with late-onset respiratory insufficiency 2 to 29 years after injury

RESULTS

All 80 patients including 74 who had arrived on 24-h tracheostomy IPPV with a tracheostomy tube cuff inflated up to 24-h a day, and the four who were intubated, were successfully placed on portable positive pressure volume adjusted, or in some cases, pressure adjusted ventilators. Two patients with late-onset respiratory failure were managed without intubation by nocturnal body ventilator support and were trained in mouth IPPV with portable positive pressure ventilators for daytime aid. The

DISCUSSION

Body ventilators and noninvasive direct airway pressure methods, including mouth IPPV and possibly-nasal IPPV, can maintain adequate alveolar ventilation in high level quadriplegic patients. This includes the patient with little or no measurable VC and no free time. Contraindications for the use of these techniques have been described and include depressed mental status and severe weakness of oropharyngeal musculature.

Ongoing polysomnography studies in our laboratory indicate that during sleep,

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This work was supported by the Department of Education Grants and Contracts Service RRD: Innovation grant G008720331.

Manuscript received December 14; revision accepted February 23.

Reprint requests: Dr. Bach, Department of Rehabilitation Medicine, University Hospital, Newark 07103

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Chest

Clinical InvestigationsNoninvasive Options for Ventilatory Support of the Traumatic High Level Quadriplegic Patient

Section snippets

PATIENTS AND METHODS

RESULTS

DISCUSSION

Chest

Int J Oral Maxillofac Surg

Arch Phys Med Rehabil

Am J Med

Chest

Chest

Chest

Complications of acute respiratory failure

Am Rev Respir Dis

Nosocomial respiratory infections with gram-negative bacilli: The significance of colonization of the respiratory tract

Ann Int Med

Bacteriologic diagnosis of nosocomial pneumonia following prolonged mechanical ventilation

Am Rev Respir Dis

Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation

Am Rev Respir Dis

Profound reflex bradycardia produced by transient hypoxia or hypercapnia in man

Eur Surg Res

Bradycardia and cardiac arrest during tracheal suction —mechanisms in tetraplegic patients

Europ J Intens Care Med

Circulatory reflexes in tetraplegics during artificial ventilation and general anesthesia

Paraplegia

Paranasal sinusitis associated with nasotracheal intubation: a frequently unrecognized and treatable source of sepsis

Crit Care Med

Tracheoesophageal fistulas following prolonged artificial ventilation via cuffed tracheostomy tubes

Anesthesiology

Evaluation and treatment of swallowing disorders

Swallowing dysfunction after tracheostomy

Ann Surg

Gollaborative study of high quadriplegia (abstract)

Arch Phys Med Rehabil

Home positive-pressure ventilation: twenty years’ experience

Chest

Comparative study of electrophrenic nerve stimulation and mechanical ventilatory support in traumatic spinal cord injury

Paraplegia

Clinical Investigations
Noninvasive Options for Ventilatory Support of the Traumatic High Level Quadriplegic Patient