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Journal of the Korean Academy of Rehabilitation Medicine 2010;34(5):518-523.
Noninvasive Respiratory Management for Patients with Cervical Spinal Cord Injury.
Choi, Won Ah , Kang, Seong Woong , Shin, Ji Cheol , Lee, Doo Yun , Kim, Dong Hyun , Kim, Sun Do
1Department of Rehabilitation Medicine and Rehabilitation Institute of Muscular Disease, Korea. kswoong@yuhs.ac
2Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Korea.
경수 손상환자에서 비침습적 호흡관리
최원아, 강성웅, 신지철, 이두연1, 김동현, 김선도
연세대학교 의과대학 재활의학교실 및 근육병 재활연구소, 1연세대학교 의과대학 흉부외과학교실
Abstract
Objective
To verify the safety and clinical utility of noninvasive respiratory management as an alternative method of invasive respiratory management for the patients with cervical spinal cord injury (CSCI) who often present with ventilatory insufficiency (due to inspiratory muscle paralysis) or difficulty in removing airway secretions (because of expiratory muscle weakness).
Method
Nineteen patients with CSCI (male: 15, female: 4, mean age: 45.6) were recruited. All of the patients were in need of mechanical ventilation due to ventilatory failure or indwelling tracheostomy tube for secretion management. In order to switch from invasive to noninvasive means of respiratory management, expiratory muscle aids such as manual assist or CoughAassist and inspiratory muscle aids such as noninvasive ventilatory support were applied to all candidates.
Results
Fifteen out of the 19 patients had indwelling tracheostomy tubes, and the remaining 4 patients were intubated via endotracheal tubes at admission. Through the noninvasive respiratory management, we were able to remove intubation or traheostomy tubes for all of the patients. Eleven patients were able to maintain normal ventilation status without ventilatory support, as time went on. The rest 8 patients were continuously in need of ventilatory support, but they could maintain normal ventilation status by noninvasive method.
Conclusion
Noninvasive respiratory management is safe and equally effective in treating ventilatory insufficiency or removing airway secretions for patients with CSCI. In cases of long-term ventilator dependency or chronic tracheostomy state, it can be replaced as a creditable alternative to invasive respiratory management. (J Korean Acad Rehab Med 2010; 34: 518-523)
Key Words: Noninvasive respiratory management, Cervical spinal cord injury


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