1262 - Breathing Beyond Barriers: Unveiling the Vital Role of Respiratory Therapy in Neurogenic Lung Disease Among Spinal Cord Patients

Friday, February 23, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

MA

Matison Alderman, MD

PGY-2
University of Miami/Jackson Health System PM&R Program
Miami, Florida, United States
SM

Sergio U. Mosquera Limas, n/a

Medical Student
NSU-KPCOM
Miami, Florida, United States

Co-Author(s)

JV

Jose R. Vives, MD

Attending Physician
Jackson Memorial Hospital/University of Miami
Miami, Florida, United States

Case Diagnosis: Traumatic C3 ASIA A Spinal Cord Injury

Case Description: A 17-year-old male airlifted to the trauma center after diving into shallow water. Evaluation revealed cervical spine fracture with a C3 ASIA A spinal cord injury (SCI). The patient was intubated due to respiratory failure, complicated with hospital-acquired pneumonia. Tracheostomy was placed as he was difficult to wean off ventilator support. Upon admission to acute inpatient rehabilitation, his poor respiratory function and difficulty managing lung secretions, made decannulation seem unfeasible. Patient received a course of antibiotics and scheduled respiratory sessions with duonebs and aggressive chest physiotherapies. Sessions included respiratory muscle training (RMT) and proning with noticeable output of secretions. After new respiratory therapy was implemented the patient was able to tolerate his capping trials, with significant improvement in respiratory function and secretion management, leading to a successful decannulation.

Discussions: Neurogenic lung disease results from dysregulation of the nervous system, which commonly occurs after SCI. This condition can adversely affect the muscles of respiration as well as the production and clearance of mucus. It comprises both restrictive pulmonary disease, with impaired ventilation, and obstructive, with increased air resistance. Respiratory therapy plays a pivotal role in mitigating these issues. It should include a combination of pharmacologic agents such as bronchodilators and anticholinergics to alleviate airway constriction and decrease secretion production, and techniques like positioning and chest physiotherapy to mechanically clear the mucus. RMT can also be used to enhance lung expansion, enabling improved respiratory function.

Conclusions: The leading cause of death in patients with spinal cord injuries is respiratory dysfunction. Patients with high cervical spinal cord injuries are at greater risk of respiratory failure given neurogenic lung disease associated with the level of injury. Effective respiratory therapies implemented early are an essential component of the rehabilitation process after a spinal cord injury and will reduce complications.