There is an increasing number of ventilator-dependent, high level quadriplegic patients discharged to the community. The options for ventilating these patients have been electrophrenic nerve stimulation for ventilation and/or tracheostomy IPPV. Potential long-term complications of tracheostomy are numerous, and EPR is extremely expensive and has not been shown to be an effective long-term alternative for the majority of patients for which it has been tried. buy asthma inhalers
Tracheostomy and tracheostomy IPPV have been considered essential in the long-term management of every high level spinal cord injured patient. The tracheostomy is also usually maintained in patients employing EPR because of the tendency of these patients to experience upper airway collapse during sleep and because phrenic pacer failure and resulting apnea can occur suddenly and without warning. Morbidity and mortality is high with these techniques. Whiteneck et al reported that 55 percent of 76 chronic ventilator-dependent spinal cord injured patients on tracheostomy IPPV or EPR had pulmonary problems yearly with an average length of hospital stay of 22 days per year.
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