Pharmacological Interventions for Pulmonary Function Improvement 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).


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.


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

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.