We would like to graciously acknowledge Christine Short, MD FRCPC for her contribution to the development of this case study.
Mr. A.H. is a 33 year old male who was involved in an ATV accident 5 weeks ago. He suffered a left clavicular fracture and multiple rib fractures, as well as a C3-4 fracture dislocation with resulting spinal cord injury. Mr. A.H. is married with two children, and has worked for 12 years as a drywaller, which is a very physical job.
He was transferred to the local acute care trauma facility where he underwent spinal fusion surgery at C3-C5. His injury is classified as C4 AIS B incomplete and he is currently in the ICU requiring mechanical ventilation (see figure 1 and 2).
Mr. A.H. is being followed by respiratory therapy and physiotherapy for chest care. His treatment involves breath stacking BID and PRN (twice a day as needed). He has had one episode of pneumonia, which has resolved.
Mr. A.H.’s wife is eager for him to start the rehabilitation phase of his recovery, but the rehabilitation facility requires that he be off of mechanical ventilation prior to admission. She would like to know about what treatment options are available to expedite weaning from the ventilator.
Figure 1. Mr. A.H.’s presenting condition.
Figure 2. C4SCI AIS B spinal injury level. From Medical Illustration (2010) Nucleus Medical Media, Inc.