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Pharmacological Interventions for Pulmonary Function Improvement during Acute SCI

Pharmacological treatments for pulmonary function in SCI patients allows for the opportunity to improve breathing and coughing (and therefore gain more independence from mechanical ventilation), and to decrease the likelihood of infection. This area of research has been explored largely in patients with chronic SCI, where bronchodilators and anabolic steroids have shown varying degrees of success (see the rehabilitation chapter on Respiratory Management in SCIRE version 5.0). Only two RCTs have investigated the use of pharmacological treatments in the acute stage of SCI. One investigated the efficacy of bronchodilator therapy with salbutamol, which dilates the bronchi and bronchioles to increase airflow to the lungs (Barratt et al. 2012); the other examined the efficacy of ambroxol, which reduces mucus secretions thereby protecting against infection (Gupta, 2010).

Pharmacological Interventions for Improved Pulmonary Function

Discussion

Although several types of bronchodilators and secretolytic agents exist, only two have been tested within the acute SCI population. Based on one study alone, bronchodilator therapy with salbutamol provided effective short-term improvements in lung function. Barratt et al. (2012) showed that these drugs increased forced vital capacity and forced expiratory volume; these improvements were maintained for half an hour. Peak cough expiratory flow also improved, but this effect deteriorated after ten minutes. The second RCT by Li et al. (2012) studied ambroxol and demonstrated more long-term improvements in pulmonary functioning. Oxygenation indexes remained elevated after five days, and patients had fewer episodes of pneumonia and hypoxemia overall. These two studies showed that pharmacological interventions may be helpful in improving breathing and reducing infection, but long-term treatments (>1 month) and the efficacy of alternative drugs remain unknown.

Conclusion

There is level 1b evidence (from one RCT; Barratt et al. 2012) that bronchodilator therapy with salbutamol improves pulmonary function compared to placebo in acute SCI patients.

There is level 1b evidence (from one RCT; Li et al. 2012) that high-dose ambroxol reduces postoperative respiratory complications and increases blood oxygenation post surgery compared to placebo in acute cervical SCI patients. 

  • Bronchodilator therapy with salbutamol may be an effective treatment for improving pulmonary function during the acute phase post SCI.

    Ambroxol may be an effective treatment to reduce pulmonary complications and improve oxygenation status post surgery in acute cervical SCI patients.