Treatment of Pulmonary Disease Following Cervical Spinal Cord Injury. EvidenceReport/Technology Assessment Number 27

摘要

Injuries at the cervical level of the spinal cord, depending on the completenessof the lesion, can lead to tetraplegia, loss of sensory function, and paralysis of the respiratory muscles. Patients with paralyzed respiratory muscles (principally the diaphragm) may not be able to breathe on their own and often must be placed on mechanical ventilators; patients with weak or paralyzed expiratory muscles (principally the abdominal and intercostal muscles) may have impaired ability to cough and clear mucoid secretions. The accumulation of retained secretions can lead to atelectasis and pneumonia. Respiratory failure is the most common cause of death for patients with cervical injuries (particularly high-cervical injuries) during the acute phase of hospitalization, and one of the three most common causes of death subsequently; 30 percent during acute hospitalization and 20 per subsequently. This report assesses the evidence currently available on the prevention and treatment of pulmonary disease following traumatic cervical SCI. The report focuses on empirical studies relating to two research questions about (1) management of ventilatory insufficiency in acute and chronic phases, including weaning from mechanical ventilation (MV), management of secretions, atelectasis and pulmonary infection, and (2) the prevention of late respiratory failure in patients with traumatic cervical SCI.