Noninvasive Options for Ventilatory Support of the Traumatic High Level Quadriplegic Patient (2)

In: Pulmonary function

27 Dec 2012

Survival percentages at one, three, five, seven, and nine years postinjury were 86, 70, 63, 59, and 63 percent, respectively indicating that about 40 percent of patients are deceased by five to nine years postinjury. Splaingard et al reported 37 percent mortality in three years for 26 traumatic spinal cord injured patients on tracheostomy IPPV including 20 patients with Cl-3 quadriplegia.

Two of these patients died by accidental disconnection. Carter et al1(i reported 17 deaths in 35 respirator-dependent quadriplegic patients on tracheostomy ventilation or EPR in an average of 1.5 years postinjury or four years postpacemaker placement, respectively. He felt that sudden death which occurred in at least nine of the patients was associated with the presence of the tracheostomy itself. Common hazards include accidental disconnection, mucous plugging with acute airway obstruction, tracheomalacia, tracheal stenosis, hemorrhage, granuloma and crusting with difficult tube changes, and chronic Gram-negative colonization with purulent bronchitis. buy ortho tri-cyclen online

There is increasing interest in the use of NVA as alternatives to tracheostomy IPPV for patients with chronic respiratory insufficiency. Noninvasive aids have been described, for the most part, in the longterm management of patients with muscular dystrophy and poliomyelitis.


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