Spinal Cord Injury

Approximately 11,000 Americans annually sustain a spinal cord injury (SCI). Nearly half of those injuries affect the upper cervical spine and result in incomplete or complete permanent quadriplegia. More than three quarters of these individuals are young males. In the past decade, as a result of improved technology and intensive rehabilitation programs, the majority of SCI patients surviving the acute phase live for decades and report satisfactory quality of life. However, SCI survivors face a lifetime of potentially serious medical complications including respiratory and kidney problems. Among these, pneumonia with respiratory failure ranks as the leading cause of death.

All high-level SCI patients have an impaired ability to clear secretions. Retained airway secretions plug bronchi, causing atelectasis, respiratory inflammation and recurrent infection. Fever and purulent sputum may mark progression to pneumonia. Because sensory nerve damage associated with quadriplegia decreases patient perception of respiratory distress, the only indication of impending respiratory failure from mucus plugging may be anxiety and increased respiratory rate. Failure to respond quickly to major mucus-plugging events may lead to respiratory arrest and death.

Regular ACT is recognized as an essential component in the standard respiratory care regimen for SCI. Many physicians prescribe high frequency chest compression (HFCC) for SCI patients who cannot mobilize airway secretions without therapeutic intervention. ACT methods requiring active participation are generally unsuitable. In patients with ineffective cough, additional techniques or devices to clear secretions from central airways are also required.

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  • Braverman J, Nozzarella M. High-frequency chest compression: Advanced therapy for obstructive lung disease. Respir Therp 2007; 2 (2): 48-51. [Link]
  • Braverman J. High-frequency chest compression; a practical intervention for secretion retention in the ICU. Respir Therp 2007; 2 (6): 26-29. [Link]