Assistive Devices and Procedures to Improve Respiratory Function

What types of assistive devices and associated procedures are used to improve respiratory function? What evidence is there for each of these assistive devices used to improve respiratory function?
1. Assistive devices and associated procedures used to improve respiratory function include: ventilator free breathing protocol, resistance and endurance training, abdominal binders, chest wall vibration, and deep-water immersion.
2. Non-invasive ventilation, phrenic nerve stimulation and diaphragmatic stimulation/pacing are all potential alternatives to traditional mechanical ventilation following SCI.
3. Resistance and endurance training should be considered in subjects who are candidates for ventilator weaning.
4. Case by case consideration should be given to tracheostomy decannulation in subjects with SCI. The indications and criteria for tracheostomy decannulation have not been established in SCI.
5. Subjects with SCI often undergo tracheostomy with decannulation occurring when the tracheostomy tube is no longer needed (See Figure 3).  
6. Abdominal binders are used to prevent the abdominal contents from falling forward in upright subjects with SCI.
7. Abdominal binding can be used to achieve immediate improvements in respiratory function, but long term effects have not been established.
8. Muscle vibration to enhance muscle contractile force has been studied in healthy individuals and in people after SCI. Vibration of the chest wall muscles may improve pulmonary function while the vibration is applied, but carry-over effects when the vibration is not in use have not been evaluated.
9. There is limited evidence that immersion to shoulder-deep 33-34° Celsius water may improve pulmonary function, but carry-over effects following immersion have not been evaluated.

For more information please see:Assisted Devices/Procedures to Assist Respiratory Function

Figure 3. Surgical Intubation. From Medical Illustration 2010, Nucelsu Medical Media, Inc.