Respiratory Management Following Spinal Cord Injury - 27

CLINICAL PRACTICE GUIDELINE

In addition, a broad range of topics should be covered: Anatomical structures and functions, including the effects of SCI on respiratory functions. Client-specific SCI issues, such as degree of independent breathing; goals and limitations of respiratory management; and respiratory health maintenance needs and requirements, including smoking cessation (Linn et al., 2000). Health-care procedures and treatments: • • • • • • • • Cardiopulmonary resuscitation. Tracheostomy care and replacement of trach tube. Bronchial hygiene protocols, chest percussion, and postural drainage. Strength and endurance exercises for respiratory muscles. Assisted coughing. Medications, inhalation therapy. Safe swallowing, voice/speech production and specimen collection. Potential problems and complications, infection control, and safety practices, including knowledge of health-care and other community resources.

Discharge Planning
38. Working with the multidisciplinary rehabilitation team, the patient and his or her family develop a discharge plan to assist the individual with ventilator-dependent spinal cord injury in transitioning from the health-care facility to a less restrictive environment, preferably a home setting.
(Scientific evidence–NA; Grade of recommendation–NA; Strength of panel opinion–Strong)

The discharge plan should include the following elements: An environment modified to accommodate wheelchair accessibility and respiratory needs. Trained 24-hour assistance. Medical resources. Appropriate durable medical equipment, including respiratory equipment. Transportation. Financial resources assessment. Leisure interests. Vocational pursuits. The discharge planning process begins in the health-care setting with a thorough evaluation of the patient, family, and social support systems; the patient’s educational and vocational background; cultural influences; and financial and living resources. Careful coordination of the patient’s resources and support systems is essential to a safe and efficacious discharge.

Commonly used respiratory supplies and equipment: • Mechanical ventilators; equipment malfunction or failure; hazards, alarms, and emergencies in the case of power failure. Humidifiers, oximeters, end-tidal CO2. Resuscitation bags. Suction equipment; response to acute threatening events, such as accidental decannulation or medical deterioration of the patient. (Anderson, 1994; DiPasquale, 1986; Dougherty et al., 1995; Splaingard et al., 1983; Zedjlik, 1992).

Home Modifications
39. Evaluate and then modify the home environment to accommodate the demands of wheelchair access and respiratory equipment.
(Scientific evidence–NA; Grade of recommendation–NA; Strength of panel opinion–Strong)

• • •

The discharge setting should include adequate access and egress. It should have space for the patient to move about in his or her wheelchair; facilities for bathing or showering; and mechanisms for heating, cooling, and ventilation. The environment should be free of fire, health, and safety hazards, and it should have adequate electrical service to support the added demands of medical equipment (American Association for Respiratory Care [AARC], 1995).

Respiratory Management Following Spinal Cord Injury

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