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Respiratory Management during the Acute Phase of Spinal Cord Injury

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Acute Respiratory Management Executive Summary

Mullen E, Faltynek P, Mirkowski M, Benton B, McIntyre A, Vu V, Teasell RW. (2019). Respiratory Management during the Acute Phase of Spinal Cord Injury. In Eng JJ, Teasell RW, Miller WC, Wolfe DL, Townson AF, Hsieh JTC, Connolly SJ, Noonan VK, Loh E, McIntyre A, editors. Spinal Cord Injury Research Evidence. Version 7.0: p 1-46.


The muscle groups required for respiration include the diaphragm, intercostals, abdominal muscles, and accessory muscles. A spinal cord injury (SCI) that occurs in the cervical or thoracic region can affect the nerves that innervate these muscles and, as a result, impair respiration. With an injury above C3, paralysis of these muscles requires lifetime ventilation for survival. Individuals with incomplete or lower level injuries are not as compromised but can still experience weakness or spasticity in these muscles that reduce respiratory flow rates and lung volumes (Galeiras Vázquez et al. 2013). Developing rigorous management and prophylactic protocols for respiration complications are key to improving patient outcomes and preventing morbidity and mortality (Berney et al. 2011). This chapter discusses the interventions available to assist with respiratory management during the acute phase post SCI. Broadly, the interventions are categorized into mechanical ventilation, non-pharmacological interventions, and pharmacological interventions.