There are limited studies examining combinations of interventions for the improvement of respiratory function post SCI. However, of those that meet the SCIRE inclusion criteria, the primary focus is on the type of ventilation received by patients: multiple, singular, or none.
A case control study by Watt et al. (2011) determined that patients who used diaphragm pacing with mechanical ventilation compared to those who only had mechanical ventilation had significantly higher survival rates. Of those patients between the ages of 31-35 years, those who were weaned from a ventilator before discharge experienced higher rates of survival compared to those that were not weaned from a ventilator before discharge (Watt et al. 2011). With respect to other respiratory parameters, when comparing endotracheal invasive ventilation with transtracheal open ventilation, there were no significant differences in partial pressure of oxygen between the two treatment types, although patients did have significantly lower partial pressure of carbon dioxide with endotracheal invasive ventilation (Gregoretti et al. 2005). The last study by Romero-Ganuza et al. (2011b) examined timing, type, and presence of tracheostomies in acute SCI patients. Of those who received an early tracheostomy there were fewer cases of tracheal stenosis compared to late tracheostomy. The type of tracheostomy that patients received also resulted in significant differences, where patients who had a percutaneous tracheostomy experienced fewer cases of pneumonia compared to surgical tracheostomy.
There is level 2 evidence (from one prospective controlled trial: Gregoretti et al. 2005) that endotracheal invasive ventilation may lower partial pressure of carbon dioxide compared to transtracheal open ventilation in acute SCI individuals.
There is level 3 evidence (from one case control study: Watt et al. 2011) that diaphragm pacing in combination with mechanical ventilation may result in higher survival than mechanical ventilation alone in acute SCI populations.
There is level 3 evidence (from one case control study: Romero-Ganuza et al. 2011b) that percutaneous tracheostomies may result in fewer cases of pneumonia compared to surgical tracheostomies in acute SCI individuals.