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Pharmacological Interventions for Pulmonary Function Improvement during Acute SCI

Table 11: Pharmacological Interventions for Pulmonary Function during Acute SCI

Pharmacological treatments for pulmonary function in SCI patients aims to improve breathing and coughing, thereby gaining 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 6.0).

Discussion

Although several types of bronchodilators and secretolytic agents exist, only two have been tested within the acute SCI population which also met the SCIRE inclusion criteria. 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 may improve 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 may reduce postoperative respiratory complications and increase blood oxygenation following 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 following surgery in acute cervical SCI patients.

Table 11. Pharmacological Interventions for Pulmonary Function during Acute SCI

Author Year

Country

Research Design

PEDro

Sample Size

MethodsOutcomes
Barratt et al. (2012)

Australia

RCT

PEDro=9

N=12

Population: Age range: 25-37 yr; Gender: male=9, female=3; Level of injury: C5-C7; Severity of injury: complete=10, incomplete=2; AIS A-B.

Intervention: Patients were randomized to receive either bronchodilator therapy (inhaler, 100 µg salbutamol) or placebo (propellant only).

Outcome Measures: The following at 10 minutes and 30 minutes after inhalation: forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and peak expiratory flow (PEF) rate.

Chronicity: The median time since injury was 24 (18-35) days.

1.     After 10 minutes, patients who received the bronchodilator therapy experienced a significant improvement in FVC (p<0.05), FEV1 (p<0.05), and PEF (p<0.05) compared to patients who received the placebo.

2.     After 30 minutes, patients who received the bronchodilator therapy experienced a significant improvement in FVC (p<0.05) and FEV1 (p<0.05) compared to patients who received the placebo. There were no significant differences between groups with regard to PEF (p>0.05).

Effect Sizes: Forest plot of standardized mean differences (SMD ± 95%C.I.) as calculated from pre- (baseline) and post-intervention (after 10 minutes) data.

Li et al. (2012)

China

RCT

PEDro=6

N=61

Population: Age range: 39-67 yr; Gender: male=40, female=21; Level of injury: cervical; Severity of injury: complete=27, incomplete=34 AIS A-B.

Intervention: Patients were randomized to receive either high-dose ambroxol (990 mg/day for 5 days) or placebo (5% glucose in 500 mL saline for 5 days) after spinal fixation surgery.

Outcome Measures: The following during hospital stay: post-operative pulmonary complications in the form of pulmonary infection, atelectasis, and hypoxemia.

The following after 3 and 5 days in the intensive care unit (ICU): arterial blood gas analysis in the form of partial pressure of inspired oxygen in arterial blood (PaO2), partial pressure of carbon dioxide in arterial blood (PaCO2), and ratio of arterial oxygen partial pressure to fractional inspired oxygen.

Chronicity: Time since injury not specified.

1.     Patients who received high dose ambroxol experienced significantly fewer episodes of pneumonia (p=0.027) and hypoxemia (p=0.047) than patients who received placebo. There were no significant differences with regards to atelectasis between groups (p=0.430).

2.     After 3 days in ICU, patients who received high dose ambroxol had a significantly higher oxygenation index than patients who received placebo (p=0.049). There were no significant differences in PaO2 (p=0.683) and PaCO2 (p=0.847) between groups.

3.     After 5 days in ICU, patients who received high dose ambroxol had a significantly higher oxygenation index than patients who received placebo (p=0.032). There were no significant differences in PaO2 (p=0.193) and PaCO2 (p=0.928) between groups.

 

Effect Sizes: Forest plot of standardized mean differences (SMD ± 95%C.I.) as calculated from pre- and post-intervention data.

One case series (n=89) (Xiong et al. 2015) revealed that individuals experiencing AD during cystolitholapaxy had larger bladder stones, a higher number of bladder stones, and longer operation time. Spinal anesthesia may be the most effective way to prevent incidence of AD in cystolitholapaxy procedures as only 2.5% of participants with spinal anesthesia experienced AD.

There is level 4 evidence (from one case series) (Xiong et al. 2015) that spinal anesthesia may be more effective at preventing incidence of AD during cystolitholapaxy compared to local or general anesthesia.