Document Detail


New approaches in the rehabilitation of the traumatic high level quadriplegic.
MedLine Citation:
PMID:  1994965     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The use of noninvasive alternatives to tracheostomy for ventilatory support have been described in the patient management of various neuromuscular disorders. The use of these techniques for patients with traumatic high level quadriplegia, however, is hampered by the resort to tracheostomy in the acute hospital setting. Twenty traumatic high level quadriplegic patients on intermittent positive pressure ventilation (IPPV) via tracheostomy with little or no ability for unassisted breathing were converted to noninvasive ventilatory support methods and had their tracheostomy sites closed. Four additional patients were ventilated by noninvasive methods without tracheostomy. These methods included the use of body ventilators and the noninvasive intermittent positive airway pressure alternatives of IPPV via the mouth, nose, or custom acrylic strapless oral-nasal interface (SONI). Overnight end-tidal pCO2 studies and monitoring of oxyhemoglobin saturation (SaO2) were used to adjust ventilator volumes and to document effective ventilation during sleep. No significant complications have resulted from the use of these methods over a period of 45 patient-years. Elimination of the tracheostomy permitted significant free time by glossopharyngeal breathing for four patients, two of whom had no measurable vital capacity. We conclude that noninvasive ventilatory support alternatives can be effective and deserve further study in this patient population.
Authors:
J R Bach
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  American journal of physical medicine & rehabilitation / Association of Academic Physiatrists     Volume:  70     ISSN:  0894-9115     ISO Abbreviation:  Am J Phys Med Rehabil     Publication Date:  1991 Feb 
Date Detail:
Created Date:  1991-03-26     Completed Date:  1991-03-26     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8803677     Medline TA:  Am J Phys Med Rehabil     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  13-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Physical Medicine and Rehabilitation Medicine, New Jersey Medical School-UMDNJ, Newark.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Breathing Exercises
Evaluation Studies as Topic
Humans
Intermittent Positive-Pressure Ventilation / instrumentation,  methods,  standards*
Lung Volume Measurements
Middle Aged
Quadriplegia / complications*
Respiratory Paralysis / etiology,  physiopathology,  rehabilitation*
Speech, Esophageal*
Tracheostomy / adverse effects,  utilization*
Ventilator Weaning

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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