Noninvasive Options for Ventilatory Support of the Traumatic High Level Quadriplegic Patient: Patients and Methods (1)

In: Pulmonary function

29 Dec 2012

Eighty ventilator-dependent traumatic quadriplegic patients including 64 male and 16 female patients with a mean age of 21.9 ±5 years at the time of injury were admitted for management of ventilator dependence and pulmonary rehabilitation from 1965 to the present. Seventy-eight of these patients had been managed by intubation and 77 by tracheostomy at some time following their acute injuries. Four of the patients presented with late-onset respiratory insufficiency 2 to 29 years after injury (one case) or after their tracheostomies had been allowed to close (three cases).
The patients underwent the management protocol in Table 1. End-tidal Pco2 monitoring, and more recently, continuous noninvasive blood gas monitoring during sleep with end-tidal Pco2 and pulse oximetry have been useful in proceeding through the steps from 24-h tracheostomy IPPV with an inflated cuff to unassisted breathing or dependence on less invasive means of ventilatory support. End-tidal Pco2 has also been used in the follow-up yearly evaluations of each patient’s assisted ventilation since 1965. Management Stages for Patients Presenting on Tracheostomy IPPV

1.    The patients were medically stabilized and the use of supplemental oxygen therapy was discontinued or minimized. Aggressive manual, and for some, mechanical assisted coughing were used as alternatives to tracheal suctioning for some patients on tracheostomy IPPV as well as for those on NVA who had not undergone tracheostomy. buy asthma inhaler

Table 1—Steps in the Pulmonary Rehabilitation of Tracheostomized Patients with High Spinal Cord Injury

Cuff Inflation Aid
Tracheotomy
Step Tube Full Partial Deflated No Cuff Fenestration Day Night
1 X X TIPPV TIPPV
2 X Night Day TIPPV TIPPV
3 X X TIPPV TIPPV or ImkK vent
4 X X X MIPPVGPB TIPPV or body vent
5 X X X MIPPV PB, GPB TIPPV or body vent
6 X X X MIPPV PB, GPB N, M, mask, IPPV or body vent
7 Button GPB, PBMIPPV

prn

N, M, mask, IPPV or body vent
8 GPB, PBMIPPV

prn

N, M, mask, IPPV or body vent

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