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Respiratory Management (Acute Phase)

Key points

Intubation can reduce arterial oxygen partial pressure ratios in acute SCI individuals.

Tracheostomies can reduce the number of pulmonary complications in acute SCI individuals compared to those not receiving this procedure, and they may result in reduced forced vital capacity and lower gas exchange compared to extubation.

Tracheostomies are associated with an increase in the number of days acute SCI individuals spend on ventilators.

Diaphragm pacing in combination with mechanical ventilation can increase survival rates post SCI.

Endotracheal invasive ventilation can lower partial pressure of carbon dioxide in acute SCI individuals.

Percutaneous tracheostomies may reduce rates of pneumonia when compared to surgical tracheostomies in acute SCI individuals.

Early tracheostomies may result in fewer 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 reduce medical complications associated with tracheostomies compared to late tracheostomies.

Weaning from mechanical ventilation 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 mechanical ventilation weaning, progressive ventilator-free breathing may be more successful than intermittent mandatory ventilation, 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 in intensive care may be reduced by extubation in combination with intensive physiotherapy.

overall may lead to reduced procedures, ventilator days, and hospital length of stay, and improved respiratory and patient discharge status, in the acute phase post SCI.

Diaphragm pacing may not reduce the number of days spent on a ventilator, however it also does not appear to increase the risk of ventilator associated pneumonia in acute SCI patients.

Intermittent positive pressure breathing can increase lung volume as well as vital lung capacity in acute SCI individuals.

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.

Respiratory management hospital programs

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