Respiratory Management Following Spinal Cord Injury - 33
CLINICAL PRACTICE GUIDELINE
33
I N D I C AT I O N S
1. To administer aerosolized medications in patients who are unable to take deep breaths without mechanical assistance. 2. Quadriplegia, other forms of neuromuscular disease, or pulmonary disease that prevents the patient from taking a deep breath. This may be evidenced by a VC less than 40% of predicted. 3. In atelectasis, when other techniques have been used without success.
GOALS
IV Aerosol Therapy—Administration of sterile water . aerosol via aerosol mask, T-piece, trach talk, or face tent, with or without heat, for the purpose of providing moisture to the airways.
I N D I C AT I O N S
1. To thin and liquefy secretions, thus aiding in mucus clearance. 2. Decrease airway inflammation. 3. Sputum induction.
DISCONTINUANCE
1. Resolve atelectasis. 2. Increase inspiratory capacity and improve FVC. 3. Relieve bronchospasm. 4. Achieve adequate distribution of ventilation.
DISCONTINUANCE
1. Improvement in breath sounds. 2. Improvement in expectoration of secretions. 3. Improvement in airway inflammation. 4. Subjective improvement by patient.
1. Atelectasis is resolved; CXR is clear. 2. Bronchospasm is relieved as evidenced by clear breath sounds. If wheezing persists, other modalities of therapy should be considered if IPPB is no longer tolerated. 3. In quadriplegia or neuromuscular disease, the VC is greater than 40% of predicted. 4. Patient is able to clear secretions. 5. Inspiratory capacity is 80% of predicted.
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
Respiratory Management Following Spinal Cord Injury - 19
Respiratory Management Following Spinal Cord Injury - 20
Respiratory Management Following Spinal Cord Injury - 21
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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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