Respiratory management for patients with SCI is thought to be most effective when the care extends beyond the individual to incorporate specialized hospital programs (Parker et al. 2010). Studies have examined the effect of respiratory management programs on enhancing patient recovery and decreasing hospital stay compared to regular hospital treatment that may differ for each person.
Overall, specialized respiratory management programs provided in the hospital for respiratory management have been shown to benefit individuals more than traditional hospital care. These programs reduce the length of hospital stay and ventilator days (Cameron et al. 2009; Vitaz et al. 2001; Richard-Denis et al. 2018), help individuals gain independence by initiating speaking valves sooner (Wong et al. 2012) and reduce the incidence of pulmonary complications (Vitaz et al. 2001). Although Wong et al. (2012) did not perform statistical analyses to compare the efficacy of their program, the patients who received all three respiratory management therapies (high tidal volume ventilation, high frequency percussive ventilation, and mechanical insufflation-exsufflation) had fewer complications than those who did not.
Cinotti et al. (2019) prospectively studied 117 patients with traumatic cervical SCI admitted to the ICU in the first 48 hours and compared outcomes between a control phase (where treatment was administered following standard hospital protocols) and an intervention phase (based on a multiple-disciplinary rehabilitation program protocol which included, among other techniques, ET) observing that a higher Delta ASIA motor score was associated with the intervention phase compared to the control phase between ICU discharge and admission and between ICU admission and 1 year follow up.
Another moderate sized case control study found that patients admitted early to a specialized level-1 trauma center overall had fewer procedures and complications compared to who? (Richard-Denis et al. 2018). Early admission to this center significantly decreased the rates of tracheostomies, as well as the total number of days in hospital. Early admitted patients spent on average 50 fewer days on ventilation (Richard-Denis et al. 2018). Another study examining specialized care by Romero-Ganuza et al. (2015) found that a third of patients were able to be weaned at the hospital, and 63/68 participants were discharged to the community and not to long-term care. More research is needed to determine how this level of specialized care compares to other standards of care.
There is level 4 evidence (from one post-test: Wong et al. 2012) that the implementation of specialized respiratory management results in stabilization and improvement of respiratory status in patients with acute SCI.
There is level 2 evidence (from one cohort study: Cameron et al. 2009) that the tracheostomy review and management service reduces length of hospital stay and duration of cannulation while increasing speech valve usage compared to those who do not receive tracheostomy review and management in patients with acute SCI.
There is level 2 evidence (from one cohort study: Vitaz et al. 2001) that the use of a clinical care pathway reduces length of hospital stay and results in fewer complications compared to those who received regular care in patients with acute SCI.
There is level 3 evidence (from one case control study: Richard-Denis et al. 2018) that early admission to a level-1 trauma center results in lower rates of tracheostomies, as well as fewer ventilator days for patients with acute SCI, compared to late admission.
There is level 4 evidence (from one pre-post test: Romero-Ganuza et al. 2015) that specialized respiratory care results in a high number of community discharges in patients with acute SCI.
There is level 4 evidence (from one pre-post study: Cinotti et al. 2019) that a multiple-disciplinary rehabilitation protocol which included, among other techniques, ET, provides a higher Delta ASIA motor score between ICU discharge and admission and between ICU admission and 1 year follow up in patients with traumatic cervical SCI who were admitted in the ICU in the first 48 hours.