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Respiratory Complications account for a significant degree of morbidity and mortality (especially w/history of COPD, asthma, Tobacco abuse) following acute SCI (and following any later hospitalization). The greatest rate of improvement in pulmonary function is in the first 3 months after the initial injury and gradual improvement thereafter up to about 1 year followed by gradual decline over years.
  • Pulmonary infections (primarily Pneumonia) → may be fulminant therefore keep a low threshold for extensive evaluation
  • Pulmonary embolus → among the highest risk groups for developing deep venous thrombosis
  • Sleep Apnea → predominantly of the obstructive or mixed types (more common in high level injury), suspect with excessive snoring, daytime somnolence, HTN refractory to treatment, nocturnal bradycardia
  • Retained secretions/atelectasis → secondary to impaired cough, reduced chest wall compliance, bronchial mucus hypersecretion, poor compensation for worsened gas exchange and hypercapnia
  • Respiratory failure → Late ventilatory failure may result from other complications including recurrent pneumonia, post-traumatic syringomyelia, restrictive pulmonary disease secondary to progressive kyphoscoliosis, cervical Spondylolisthesis and stenosis with progressive myelopathy, and obesity

Treatment recommendations primarily focus on prevention.

  1. Vaccinate all against pneumonia and influenza when appropriate
  2. Minimize sedative and narcotic medication and reduce obesity
  3. Encouragement of deep breathing: Frequent changes of position, Incentive Spirometry, Postural drainage of secretions, Nasotracheal suctioning, Manually Assisted Coughing (video example) using forceful upper abdominal thrusts in a posterior and cephalad direction (quad cough), expeditious use of bronchodilators/IPV/nubulizers.
  4. Intermittent glossopharyngeal breathing in high cervical level patients utilizes oral, pharyngeal, and laryngeal muscles to enhance ventilation by projecting boluses of air past the glottis should a vent fail (video example)

Pulmonary Testing & Referral Conditions



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The University of Alabama at Birmingham Spinal Cord Injury Model System provides this website as an auxiliary resource for the primary care of patients with spinal cord injury.The contents of this website were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90SIMS0020). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this website do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.