AA

Methods

A literature search was performed using the following databases: Cochrane Library, PubMed/MEDLINE, EMBASE, CINAHL, and Scopus. The following search terms were entered: (spinal cord injury OR paraplegia OR quadriplegia OR tetraplegia) AND respiratory, respiration, pulmonary, inspiratory muscle training, respiratory muscle strength, bronchodilators, bronchial hyperresponsiveness, ipratropium, metaproterenol, salbutamol, salmeterol, anabolic steroid, ambroxol, ventilation, ventilator, phrenic nerve stimulation, diaphragmatic stimulation, tracheostomy, atelectasis, intermittent positive pressure breathing, abdominal binder, vibration, secretion, pneumonia, lung abscess, abdominal neuromuscular electrical, or stimulation. Each search term after the brackets was added separately.

The following limits to the search were applied: the article must have been published between January 1, 1990 and January 1, 2015, in English, and included humans over the age of 18 years. The search was restricted to journal articles, reviews, and systematic reviews; grey literature and conference abstracts were excluded. The studies had to include a minimum of 3 patients, of which 50% had spinal cord injuries, unless the results were stratified. The original search resulted in 5870 unique articles. After removing articles that were irrelevant to the topic, did not abide to the aforementioned inclusion criteria, were case studies, or were articles that were considered ‘chronic’ respiratory management, 52 remained that examined respiratory management in the acute phase of SCI. During this process, additional papers were added as a result of cross-referencing between studies. Articles were considered to be ‘acute’ and therefore suitable for inclusion in this chapter if the participants in each study were enrolled within approximately 1 month of their injury, or if the article did not report the time frame but made it clear that the study was conducted soon after the initial admission to hospital. For studies examining ventilator weaning and physiotherapy, the criteria was more relaxed and included studies where patients began enrollment within 1 month following injury, and were included up to 4 months post injury.