Key Points
Intubation can reduce arterial oxygen partial pressure ratios in people with acute SCI.
Tracheostomies can reduce the number of pulmonary complications in people with acute SCI compared to those not receiving this procedure, and they may result in reduced forced vital capacity (FVC) and lower gas exchange compared to extubation.
Tracheostomies are associated with an increase in the number of days people with acute SCI spend on ventilators.
Diaphragm pacing in combination with mechanical ventilation (MV) can increase survival rates post SCI.
Endotracheal (either endotracheal tube or tracheostomy tube) invasive ventilation (EIV) can lower partial pressure of CO2 in people with acute SCI.
Percutaneous tracheostomies may reduce rates of pneumonia when compared to surgical tracheostomies in people with acute SCI.
Early tracheostomies may result in fewer intensive care unit (ICU) days and ventilation days; however, they may not impact in-hospital mortality, compared to late tracheostomies.
The evidence is inconsistent regarding whether or not early tracheostomies vs. late tracheostomies reduce medical complications.
Weaning from MV is more successful in patients who have not had a tracheostomy, and rates of decannulation and extubation are higher in patients with lower-level injuries during the acute phase post SCI.
For MV weaning, progressive ventilator-free breathing (PVFB) may be more successful than intermittent mandatory ventilation / invasive mechanical ventilation (IMV), and using higher ventilator tidal volumes may speed up the weaning process compared to lower ventilator tidal volumes during the acute phase post SCI.
Mechanical insufflation/exsufflation coupled with manual respiratory kinesitherapy may be effective for bronchial clearance during the acute phase post SCI.
Inspiratory and expiratory muscle training may improve respiratory muscle function during the acute phase post SCI.
Length of stay (LOS) in intensive care may be reduced by extubation in combination with intensive physiotherapy.
Bronchodilator therapy with salbutamol (albuterol) may be an effective treatment for improving pulmonary function during the acute phase post SCI.
High dose ambroxol may be an effective treatment to reduce pulmonary complications and improve oxygenation status following surgery in patients with acute cervical SCI (this is unavailable in Canada or USA).
Specialized respiratory management programs provided in the hospital may lead to reduced procedures, ventilator days, hospital LOS, and improved respiratory and patient discharge status, in the acute phase post SCI.
