Respiratory Management Following Spinal Cord Injury - 1
CLINICAL PRACTICE GUIDELINE
1
Summary of Recommendations
Initial Assessment of Acute SCI
1. Guide the initial management of people presenting with suspected or possible spinal cord injury in the field and in the emergency department using the American Heart Association and the American College of Surgeons’ principles of basic life support, advanced cardiac life support, and advanced trauma life support. 2. Perform an initial history and physical exam to include the following: Relevant past medical history. Prior history of lung disease. Current medications. Substance abuse. Neurologic impairment. Coexisting injuries. 3. The initial laboratory assessment should include: 6. Intubate the patient for the following reasons: Arterial blood gases. Routine laboratory studies (complete blood count, chemistry panel, coagulation profile, cardiac enzyme profile, urinalysis, toxicology screen). Chest x-ray. EKG. Conduct periodic assessments of respiratory function to include: Respiratory complaints. Physical examination of the respiratory system. Chest imaging as indicated. Continuous pulse oximetry. Performance of the respiratory muscles: vital capacity (VC) and maximal negative inspiratory pressure. Forced expiratory volume in 1 second (FEV1) or peak cough flow. Neurological level and extent of impairment. Intractable respiratory failure, especially if continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BiPAP) or noninvasive ventilation has failed. Demonstrable aspiration or high risk for aspiration plus respiratory compromise. 7. If the vital capacity shows a measurable decline, investigate pulmonary mechanics and ventilation with more specific tests. 8. Implement the following steps to clear the airway of secretions: Assisted coughing. Use of an in-exsufflator/exsufflator. Intermittent Positive Pressure Breathing (IPPB) “stretch.” Glossopharyngeal breathing. Deep breathing and coughing. Incentive spirometry. Chest physiotherapy. 4. Monitor oxygen saturation and end tidal CO2 to measure the quality of gas exchange during the first several days after injury in correlation with patient expression of respiratory distress.
Prevention and Treatment of Atelectasis and Pneumonia
5. Monitor indicators for development of atelectasis or infection, including: Rising temperature. Change in respiratory rate. Shortness of breath. Increasing pulse rate. Increasing anxiety. Increased volume of secretions, frequency of suctioning, and tenacity of secretions. Declining vital capacity. Declining peak expiratory flow rate, especially during cough.
Respiratory Management Following Spinal Cord Injury
Table of Contents for the Digital Edition of Respiratory Management Following Spinal Cord Injury
Respiratory Management Following Spinal Cord Injury
Contents
Preface
Acknowledgments
Panel Members
Contributors
Summary of Recommendations
The Consortium for Spinal Cord Medicine
Recommendations
Recommendations for Future Research
Appendix A: Respiratory Care Protocol
Appendix B: Protocol for Ventilator-Dependent Quadriplegic Patients
Appendix C: Wean Protocol for Ventilator-Dependent Quadriplegic Patients
Appendix D: Wean Discontinuation Protocol
Appendix E: Cuff Deflation Protocol for Ventilator-Dependent Quadriplegic Patients
Appendix F: Cuff Deflation Discontinuation Protocol
Appendix G: High Cuff Pressures Protocol
Appendix H: Post-Tracheoplasty/Post-Extubation Protocol
Appendix I: Criteria for Decannulation of Trach Patients
Appendix J: Evaluation of High Peak Pressure on Mechanically Ventilated Patients
References
Index
Respiratory Management Following Spinal Cord Injury - Respiratory Management Following Spinal Cord Injury
Respiratory Management Following Spinal Cord Injury - Cover2
Respiratory Management Following Spinal Cord Injury - ii
Respiratory Management Following Spinal Cord Injury - Contents
Respiratory Management Following Spinal Cord Injury - iv
Respiratory Management Following Spinal Cord Injury - Preface
Respiratory Management Following Spinal Cord Injury - Acknowledgments
Respiratory Management Following Spinal Cord Injury - Panel Members
Respiratory Management Following Spinal Cord Injury - Contributors
Respiratory Management Following Spinal Cord Injury - ix
Respiratory Management Following Spinal Cord Injury - Summary of Recommendations
Respiratory Management Following Spinal Cord Injury - 2
Respiratory Management Following Spinal Cord Injury - 3
Respiratory Management Following Spinal Cord Injury - 4
Respiratory Management Following Spinal Cord Injury - The Consortium for Spinal Cord Medicine
Respiratory Management Following Spinal Cord Injury - 6
Respiratory Management Following Spinal Cord Injury - 7
Respiratory Management Following Spinal Cord Injury - Recommendations
Respiratory Management Following Spinal Cord Injury - 9
Respiratory Management Following Spinal Cord Injury - 10
Respiratory Management Following Spinal Cord Injury - 11
Respiratory Management Following Spinal Cord Injury - 12
Respiratory Management Following Spinal Cord Injury - 13
Respiratory Management Following Spinal Cord Injury - 14
Respiratory Management Following Spinal Cord Injury - 15
Respiratory Management Following Spinal Cord Injury - 16
Respiratory Management Following Spinal Cord Injury - 17
Respiratory Management Following Spinal Cord Injury - 18
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Respiratory Management Following Spinal Cord Injury - 24
Respiratory Management Following Spinal Cord Injury - 25
Respiratory Management Following Spinal Cord Injury - 26
Respiratory Management Following Spinal Cord Injury - 27
Respiratory Management Following Spinal Cord Injury - 28
Respiratory Management Following Spinal Cord Injury - 29
Respiratory Management Following Spinal Cord Injury - Recommendations for Future Research
Respiratory Management Following Spinal Cord Injury - Appendix A: Respiratory Care Protocol
Respiratory Management Following Spinal Cord Injury - 32
Respiratory Management Following Spinal Cord Injury - 33
Respiratory Management Following Spinal Cord Injury - Appendix B: Protocol for Ventilator-Dependent Quadriplegic Patients
Respiratory Management Following Spinal Cord Injury - 35
Respiratory Management Following Spinal Cord Injury - Appendix C: Wean Protocol for Ventilator-Dependent Quadriplegic Patients
Respiratory Management Following Spinal Cord Injury - Appendix D: Wean Discontinuation Protocol
Respiratory Management Following Spinal Cord Injury - Appendix E: Cuff Deflation Protocol for Ventilator-Dependent Quadriplegic Patients
Respiratory Management Following Spinal Cord Injury - 39
Respiratory Management Following Spinal Cord Injury - Appendix F: Cuff Deflation Discontinuation Protocol
Respiratory Management Following Spinal Cord Injury - Appendix G: High Cuff Pressures Protocol
Respiratory Management Following Spinal Cord Injury - Appendix H: Post-Tracheoplasty/Post-Extubation Protocol
Respiratory Management Following Spinal Cord Injury - Appendix I: Criteria for Decannulation of Trach Patients
Respiratory Management Following Spinal Cord Injury - Appendix J: Evaluation of High Peak Pressure on Mechanically Ventilated Patients
Respiratory Management Following Spinal Cord Injury - References
Respiratory Management Following Spinal Cord Injury - 46
Respiratory Management Following Spinal Cord Injury - 47
Respiratory Management Following Spinal Cord Injury - 48
Respiratory Management Following Spinal Cord Injury - Index
Respiratory Management Following Spinal Cord Injury - Cover3
Respiratory Management Following Spinal Cord Injury - Cover4
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